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3/3-"/
INorm Larouna iiaie L.u.vjry
Raleigh
MEDICAL PROFESSIONS EDITION
Volume 23, No. 3-4
l"HE
QUARTERLY
*s
.
^0^
v
Kendall
problems created by
CHAIRMAN'S
COMMENTS
Henry E. Kendall
Chairman
N. C. Employment
Security Com/mission
?*1 "The rapid advances in medical
science and technology added to the
aroused public interest in attaining
and maintaining high quality of
health services have compounded the
health manpower shortages." This
statement was made by Dr. Edwin L. Crosby, President of
the National Health Council. Dr. Crosby continued: "The
national interest and concern today have placed more
emphasis on the needs for more health workers to provide
the optimum of services and facilities to maintain a high
level of health for our citizens."
The nation faces a shortage of qualified and skilled medical
service workers at a time when increasing population taxes
existing hospital and other medical facilities. In North Caro-lina,
our hospitals are short handed. Our public and private
medical research staffs need additional people, and medical
institutions are crowded with patients. The doctor-patient
ratio in North Carolina is one to 11,000.
"And the critical situation we face now in North Carolina
and in the nation will get worse before it gets better,"
reports the State Department of Health.
"Today the need for young people in the field of medical
science is at its highest peak in the history of medicine,"
reports the North Carolina Society of Medical Technologists.
"Today there are more and better prepared nurses in North
Carolina than ever before. Yet, in nearly every community
in the State," according to the N. C. State Nurses Associa-tion,
"there is considerable public attention and concern about
the shortage of nurses."
Commenting on the medical demands exerted by the new
Medicare Law, the Health Planning Council for Central
North Carolina predicted that "we will continue to pay the
price of shortages of personnel and facilities, expensive
instances of duplicated effort, and inefficient utilization of
skilled health workers. This unhappy condition will persist
until we awaken to the necessity for far better planning in
this field than has generally been the case heretofore."
This is the first issue of the ESC QUARTERLY ever
devoted to shortage occupations, in this case health service
and medically related professions. Our solicitation for articles
disclosed serious personnel shortages in a number of North
Carolina medical institutions. These shortages, which have
gradually increased during the past decade, came basically,
because the number of persons entering health service
occupations has not kept pace with the growing demands for
medical treatment from an increasing population.
One organization in North Carolina, "Health Careers,"
was established solely to recruit and influence young persons
toward health service jobs, and all of our medical insti-tutions
and professional associations, in some degree are
assuming the task of personnel training to fill job vacancies.
Most industries in our State require additional skilled
workers, and our health service industry, if it can be called
that, is in no less straits for the qualities of skilled and
trained technicians—whether it be the clinical competence of
a laboratory director, the efficiency of a registered nurse, the
dexterous sense of the physician or the professionalism of
the hospital administrator.
(Continued on page 23)
2 ESC QUARTERLY
THE
ESC QUARTERLY
MEDICAL SERVICE INDUSTRY
Volume 23, No. 3, 4, 1965
Issued at Raleigh, N. C, by the
EMPLOYMENT SECURITY COMMISSION
OF NORTH CAROLINA
Commissioners
Billy Earl Andrews, Durham; Charles L. Hun]
Monroe; James W. Seabrook, Payetteville ; Henry
Kendall, Raleigh; Harold F. Coffey, Lenoir; R. Di
Hall, Belmont; Samuel F. Teague, Raleigh.
State Advisory Council
Public representatives: James A. Bridger, Blad
boro, Chairman: Sherwood Roberson, Robersonvil
Mrs. W. Arthur Tripp, Greenville; Employer rep
seniatives: A. L. Tait, Lincolnton and G. Maur
Hill, Drexel. Employee representatives: Mer
Ward, Spencer, AFL, and H. D. Lisk, Charlotte, 1
HENRY E. KENDALL Chairn
R. FULLER MARTIN Dirl
Unemployment Insurance Division
JOSEPH W. BEACH DireJ
State Employment Service Division
H. E. (Ted) DAVIS , Ed
Public Information Officer
|
Sent free upon request to responsible individual
agencies, organizations and libraries
Address: E.S.C. Information Service,
P. O. Box 589, Raleigh, N. C.
COVER LEGEND
What better illustration to
medical services than the sm
faced youngster and the public r
nurse? Perhaps no other prof
instills such dedication as the
herent in our medical servants
we wonder just how many va
tions have been given by the
lady and how many bright eyes
watched her shining needles. Despite his age, the si
bewildered young man is, perhaps, not unlike us c
Our knowledge of medicine and medical practice
methods is often bewildering, and we are wholly ine
prognosis and treatment without the physicians and
protessionals. The young lady in the picture we b
illustrates the opportunities which exist among the m
services, because from every contributor to this iss
the Quarterly we learn of a growing shortage of f
>ei
sional medical workers.
MEDICAL SERVICE WORKERS TRAINED UNDER FEDERAL STATE PROGRAMS
By Dave Garrison
Bureau of Employment Security Research
Almost 1,700 workers have been
ained for North Carolina's hospi-ils
and medical-eare institutions un-jr
the Manpower Development and
raining Act since its passage in
)62. Designed to reduce unemploy-ed,
the MDTA has enabled many
arsons to qualify for jobs which they
ight not have otherwise obtained,
t the same time, the program has
rovided a trained labor supply in
any hospital and related occupa-ons,
which traditionally have be^n
ifficult to fill.
Under institutional-type training
rograms, which are administered by
le Department of Community Col-ges
of the State Board of Educa-on,
there have been 509 persons
irolled in 13 different MDTA train-lg
projects, located in the Durham,
reensboro, Kinston, Morganton, New
ern, Rocky Mount, Spruce Pine and
/ilson areas. Although some of these
rograms are not yet completed,
mailable reports on the post-training
nployment experience of the trainees
idicate that 235 trainees have se-ared
employment directly related to
ieir training. The institutional pro-rams
developed thus far have been
mited to four occupational fields:
urse aide, ward attendant, psychia-
'ic attendant, and dental hygienist.
Perhaps because training of work-rs
in medical occupations lends it-jlf
more readily to on-the-job type
ituations where facilities, equipment
nd instructors are usually already
vailable, the MDTA on-the-job train-ig
programs, administered through
ie U. S. Bureau of Apprenticeship
nd Training, have been more wide-pread
than the institutional type
rograms. To date nearly 1,200 per-ms
have been enrolled in on-the-job
raining programs in hospitals lo-ated
in Concord, Chapel Hill, Greens-oro,
Mount Airy, North Wilkesboro,
parta, Jefferson, Wilson and Win-ton-
Salem. Of 980 persons who have
lready completed OJT training, 753
ave remained in training related
ibs.
A much greater variety of training
as been offered under the OJT pro-ram,
ranging from lower skilled
)bs, such as orderly and maids, to
ie more complex occupations of
iboratory technician and staff nurse
upgrading).
MDTA TRAINING IN HOSPITAL OCCUPATIONS
INSTITUTIONAL PROJECTS
Current
Area Occupation Approved Enrolled Completed Enrollment
Durham Ward Attendant 40 31 27
Greensboro Nurse Aide 30 35 30
Greensboro Nurse Aide :;o 29 13 15
Greensboro Dental Hygienist 60 20 20
Kinston Nurse Aide 30 23 20
Morganton Ward Attendant 180 156 156
Morganton Psychiatric Attendant 50 36 34
Morganton Ward Attendant 48 29 27
New Bern Nurse Aide 15 16
Rocky Mount Nurse Aide L5 15 15 I)
Spruce Pine Nurse Aide 11 15 14
Wilson Nurse Aide 45 45 11 I)
Wilson Nurse Aide <;o 59 36
Total Inst. 617 509 413 35
Area
Charlotte
Concord
Concord
Concord
Concord
Concord
Concord
Chapel Hill
Greensboro
Greensboro
Greensboro
Greensboro
Greensboro
Mount Airy
Mount Airy
Mount Airy
Mount Airy
Mount Airy
Mount Airy
North Wilkesboro
North Wilkesboro
North Wilkesboro
North Wilkesboro
North Wilkesboro
North Wilkesboro
Sparta
Sparta
Sparta
Jefferson
Jefferson
Jefferson
Jefferson
Wilson
Wilson
Wilson
Wilson
Wilson
Wilson
ON-THE-JOB TRAINING PROJECTS
Occupation
Food Service Worker
Porter
Ward Maid
Hospital Aide
Hospital Orderly
Ward Clerk
Food Service Worker
Operating Room Tech.
Food Service Worker
Ward Maid
Hospital Aide
Hospital Orderly
Housekeeping Orderly
Porter I
Ward Maid
Ward Clerk
Hospital Aide
Hospital Orderly
Food Service Worker
Porter I
Ward Maid
Hospital Orderly
Ward Clerk
Hospital Aide
Food Service Worker
Hospital Orderly
Ward Clerk
Hospital Aide
Ward Clerk
Hospital Aide
Hospital Orderly
Lab. Tech.—Medical
Posting Machine Opr.
Insurance Clerk
Inventory Clerk
Switchboard Inform. Opr,
Emergency Room Clerk
Cashier Admitting Clerk
(See MDTA, page 65)
Current
Approved Enrolled Completed Enrollment
36
35
26
72 22 16 7
14 2
2 4 4
28 16
36 28 19
28 16 16
16
50 5!) 41 13
18 17 10 3
17 13 11
7 7 7
8 7 7
10
50 36 33
12 8 8
8 8 7
7 5 5
8 7 7
10 5 5
5 5 5
20
12 (I
8 5 4 1
4 2 2
16 16 8 8
5 4 4
23 8 8
10
5
2 2 2
2 2 2
1
7 4 4
2 3 3
6 7 6
ESC QUARTERLY
New Occupations, New Skills Emerge
From Expanding Medical Services
By Stanly Rose
ESC Occupational Analyst
Health is a big and expanding busi-ness
in the United States. Measured
by the number of people employed,
the 1960 census rates the health field
as our third largest industry, exceed-ed
only by agriculture and construc-tion.
During the 1950's, the health
field's rate of gain in employment
was four times higher than that for
national employment as a whole.
More than 2.6 million people were
employed in this field in 1962, accord-ing
to the U. S. Public Health Ser-vice.
This represents an increase of
around 50 per cent since 1950.
Who are these health field workers
and where are they found? The physi-cian
is probably the best known
worker in this field. Physicians, how-ever,
surprisingly account for only
nine out of every 100 health workers.
Other professional people such as
nurses and technical workers ac-count
for 37 and roughly the same
number is found in service and main-tenance
categories. The remaining
seventeen workers are found in ad-ministrative
and office work. These
ROSE
workers are found in many different
places including hospitals, clinics,
laboratories, pharmacies, nursing
homes, industrial plants, private of-fices,
and patients' homes.
Will Continue to Expand
Expansion of the health field can
be attributed to a number of factors.
Our population is growing and the
4 ESC QUARTERLY
rate of increase is highest among
children and older people, both in age
groups where health needs are great-est.
The general public today is more
health conscious than ever before,
and higher levels of income in recent
years have enabled many individuals
to purchase more extensive hospitali-zation
and medical insurance cover-age,
thus creating a demand for more
medical and health services. Recent
increases in expenditures for medical
research both by the federal govern-ment
and private foundations have
led to an increase in knowledge and
many technological advances, some
of which now permit successful treat-ment
of patients considered terminal
cases a few years ago.
These factors along with the recent
passage of the Medicare Bill have
caused, and will probably continue to
cause, the health field to expand.
New Occupations
This increase in knowledge and
technological advances resulting from
medical research has created many
new occupational specialties that did
not exist ten to 15 years ago. A com-paratively
new member of the health
profession is the cytotechnologist.
This worker is trained in the use of
special laboratory techniques for de-tecting
body cell changes. These
changes are particularly important
in the early diagnosis of cancer. Cell
samplings, stained with special dyes
to make the cytoplasms and nuclei
stand out brightly when magnified,
are mounted on slides and screened
under a microscope to detect clues
to disease in the patterns of cyto-plasms
and nuclei. Abnormalities
often can be warning signs of can-cer
and frequently enable the physi-cian
to detect and treat this disease
long before it could be detected by
any other method.
Another new member of the health
field is the medical engineer. This
worker, an engineering graduate with
specialized courses generally in bio-physical
sciences, is concerned with
the development of new kinds of in-struments
for use in medical or
surgical care, or in research. His
efforts may also be directed toward
the invention or perfection of devices
to repair or compensate for parts of
the human body that do not function
correctly, or to the adoption of com-puter
technology to medical research.
Other new areas of specialization
include biomathematics which is the
application of mathematical princi-ples
to the life sciences, and nuclear
medical technology which involves the
use of radioactive isotopes in tests
to help diagnose and treat disease.
While many new jobs have emerged
in recent years, a considerable num-ber
of the older jobs in the health
field have been changed significantly
during this time in relation to job
content, performance requirements
and responsibilities.
Medical technologists, for example,
still perform the scientific fact-finding
tests that help track down the cause
and cure of disease, but they now
have a vast array of special scien-tific
instruments and machines that
enable them to perform more tests
in less time with less percentage of
error. According to one hospital
spokesman, a new machine has been
ordered for his hospital that will per-form
12 different types of analysis on
an individual's blood within two
minutes, whereas four to eight hours
formerly was required by a compe-tent
technologist to complete these
tests.
More Information Needed
The emergence of new jobs and
changes occurring in many of the
older jobs has created a need for
accurate occupational information to
aid personnel in the health field in
selecting and hiring competent appli-cants,
and to aid public employment)
service personnel in their placement
and counseling activities. To this end,
the United States Employment Ser-!
vice in cooperation with the American
Hospital Association has initiated a
job analysis project designed to give
a clearer understanding of job duties
and organizational structures foundj
in hospitals and related health ser-|
vices.
This new project involves the studyj
and preparation of job analysis
schedules of all jobs found in hospi
tals and related health services
Analysts from eight Occupationa
Analysis Field Centers (including
North Carolina) presently are study
ing jobs in hospitals (large an(
small) throughout the country. It is
anticipated each job will be studiet
by at least two analysts in two dif
ferent parts of the country to insun
a comprehensive coverage. When
studies are completed, the informa
tion obtained will be reviewed an<
edited by employment service per
sonnel at the national level and als
by personnel from the Americai
(See HEALTH JOBS, page 50)
1 Doctor
11,000 Patients
By Dr. George W. Paschal, Jr.
Editors Note: The following article was prepared by Dr. Paschal when he was
serving as President of the N. C. Medical Society.
There exists today in North Caro-lina
and the United States, a short-age
of personnel in the medical and
health fields. This shortage is more
evident among those in the para-medical
area than that of physicians
themselves. Doctors are aware that,
for them to function at maximum
efficiency, it is necessary to encour-age
a program for recruitment of the
allied health workers and at the same
time make available to them quali-fied
sources of training. Properly
motivated, properly educated people
can find a rewarding opportunity for
service in health careers. They can
also make possible expanded and
broadening capabilities of the indi-vidual
physician.
National Average
Our problem in North Carolina is
primarily one of proper distribution
of modern medical care. There are
some 3800 members of the Medical
Society of the State of North Caro-lina.
There are about 4900 doctors
licensed to practice medicine in North
Carolina. Those not members of the
medical society are to be found chief-ly
among the large numbers of phy-sicians
at our three Medical Centers
and working in our state operated
institutions. Our doctor-patient ratio
of 1:11,000 is not unfavorable when
compared with the national average,
but this figure alone does not repre-sent
a true picture when we consider
that the three counties in which our
medical schools are located have a
concentration of medical manpower
which gives an atypical appearance
for the State as a whole.
A number of so-called rural com-munities
in North Carolina are in
need of physicians. This, however,
does not necessarily mean that peo-ple
in these communities are beyond
reach of the services of a doctor.
Warren County is an example where
there is a real scarcity of doctors.
People in need of medical service now
go to clinics, hospitals and the offices
of physicians outside of their com-munity.
It is lamentable that many
in need of care, possibly forego the
effort to secure it. Yet, for those who
must have care—care is available. It
is a price for care, however, that we
want to see eliminated. To graduate
more physicians, in itself, is not the
answer. It is recognized that that
would help but something must be
done to demonstrate to young doc-tors
the pleasures and satisfaction of
non-urban practice. Communities
themselves must become concerned
about this problem and develop pro-grams
to improve schools, expand
ESC QUARTERLY
economic opportunity, provide ade-quate
shopping facilities, make avail-able
participation in the arts, and
have appropriate recreational facili-ties.
Such a regional effort would
likely attract and keep young doctors
and their wives.
North Carolina is unique in its
opportunity for the training of phy-sicians.
Except for earlier transient
schools there was not a four-year
school of medicine in North Carolina
until the early 1930's. In 1902, Wake
Forest College established a 2-year
medical school and in 1940 moved to
Winston-Salem to become the Bow-man
Gray School of Medicine, confer-ring
the M.D. degree. The University
of North Carolina expanded its med-ical
school to a 4-year program in
1951 after operating as a 2-year
school since 1896. Until 1930, our
students were forced to go out of the
state for their education. Many of
our better physicians received their
education and training beyond our
borders and have never returned, now
holding positions of distinction at
other medical schools or hospitals.
Best Public Health Service
Now our people can go to school
in the state and their chances of re-maining
are enhanced. Our three
medical schools are now graduating
some 225 MD's yearly and plans are
for further expansion of the num-bers
in each class of each school.
In addition to our medical schools
we have our excellent School of Pub-lic
Health at the University of North
Carolina, established by our legisla-ture
in 1937. It is one of four in the
United States and provides a supe-rior
source of training for our phy-sicians
in the field of public health.
As a result of this and other factors,
North Carolina enjoys possibly the
best rounded public health services
of any State in the Union.
The medical centers of our three
teaching institutions provide the
principal source of post-graduate and
residency training for physicians in
North Carolina. Other hospitals in
our larger cities have residency pro-grams
which have full or limited ac-creditation
for the continued educa-tion
of the physician. The University
of North Carolina has a post-gradu-ate
program which is available to the
doctors of North Carolina through
local medical societies. The Academy
of General Practice regularly makes
available courses of instruction to
provide continuing education for gen-eral
practitioners. The State Medical
Society, county societies, local hos-pitals,
specialty groups and others
are constantly holding symposia or
conferences for the prime purpose of
making possible the continuation of
the educational process.
Health Legislation
Public Law 89-239, enacted in 1965,
which has to do with heart, cancer
stroke and related diseases, probablj
will have a greater long range im-pact
than any legislation thus fai
passed in the health field. Its chiel
purpose is to provide better medica
care and continuing education. In th<
latter, North Carolina will have its
opportunity, provided our applicatior
to the National Institutes of Healtr
for planning and operational grants
is approved. Under this prograir
our three medical schools will oper-ate
the program in which eventual!}
all hospitals in North Carolina wil
have the opportunity to participate
The medical society is encouraging
participation. With the advantages oJ
giant computers and modern means
of communication, it is envisagec
that all doctors in the state will b<
within access of consultative anc
training services.
Not the least of physician training
and continuing education comes fron
available medical literature. Th<
American Medical Association is th<
world's leading publisher of medica
journals, most of which are furnishec
to the member without cost. Special-ists
have their own journals and th<
list is imposing. The chance for train
ing and unending education is avail
able for all. Most all take advantagt
of it, one way or another. Most ar<
sincerely motivated to provide mod
em medical care to the patient hi
serves.
DR. GEORGE W. PASCHAL, JR.,
is a native of Wake Forest and
attained PA, BS, MED and MD
degrees from Wake Forest College
and Jefferson Medical College. Fifty-eight
years old, Dr. Paschal was
licensed as a practicing physician in
North Carolina in 1931. He joined
the Wake County and N. C. Medical
Society in 1946 and has since been
active in numerous committees, in-cluding
chairmanship of the Medical
Advisory Committee to the State
Selective Service System, an appoint-ment
made by President Truman.
Dr. Paschal was elected President
of the N. C. Medical Society in 1965
and served a one-year term. Prior to
his residency in North Carolina, he
interned at the Hospital of Protestant
Episcopal Church in Philadelphia from
1931-33. He entered general practice
in New Brunswick, N. J., in 1933 and
was a member of the New Jersey
Medical Society. Dr. Paschal's resi-dency
training in surgery was per-formed
at Jefferson Hospital, 1938-41,
and during that time he became a
member of the Pennsylvania Medical
Society. He was senior assistant sur-geon
at the Philadelphia General Hos-
6 ESC QUARTERLY
pital, 1939-42, and attending surgeon
at the local Joseph Price Hospital.
From 1942-46 Dr. Paschal served
in the U. S. Army Medical Corps,
attaining the rank of Lieutenant
Colonel. He was chief of the surgical
service of the 38th General Hospital
in the Army and was surgical con-sultant
of the Africa-Middle East
theater in 1945.
He returned to North Carolina in
1946.
In Raleigh Dr. Paschal is presently
attending surgeon at Rex and Wake
Memorial Hospitals. He is chief of
the surgical department at Mary
Elizabeth Hospital and was chief of
the surgical service at St. Agnes
Hospital, 1952-61.
Affiliated with approximately 30
professional and educational insti-tutions
and organizations, Dr. Paschal
serves as a member of the N. C.
Chapter of American College of Sur-geons;
is a fellow of the American
College of Surgeons; and is a member
of the N. C. Surgical Association, the
Southern Society of Clinical Surgeons,
and the Southeastern Surgical Con-gress.
Dr. Paschal also serves as a
member of the Board of Directors of
Mary Elizabeth Hospital and the
PASCHAL
Hospital Care and the Hospital Sai
ings Associations. He is a member c
the board of Directors of Wat
Forest College and a member of th
Committee on Disaster Medical Cai
and the Council on National Securit
of the American Medical Associatioi
A critical shortage of health per-snnel—
trained specialists needed to
taff hospitals, clinics and laboratories
-exists in North Carolina today and
redictions indicate future shortages
iat may curtail health services es-mtial
to the people.
The diseased must be cured. The
ljured must be treated. And babies
ill have to be delivered.
To perform these tasks for its ex-anding
population, North Carolina
lust increase the number of profes-onal
and technical personnel avail-ble
to fill medical and health jobs.
To meet the problem, Health Ca-pers
for North Carolina, a statewide
rogram to inform students of health
ireer opportunities, was established
i 1963. Results of this program to
ate are promising, but ever-increas-ig
needs have checked gains in re-fitment.
Recruitment Program
The statewide program is an en-largement
of a three-year pilot proj-ect
originated in the western coun-ties
of the State in 1959. A shortage
of nurses in the Asheville area
prompted hospital administrators to
raise funds for the promotion of
health careers.
In Raleigh, the Board of Trustees
of the North Carolina Hospital Asso-ciation,
after viewing the success of
the Asheville program and predicting
the need for greater numbers of
trained personnel throughout the
state, established the Health Careers
for North Carolina recruitment pro-gram.
The Board sought and received
sufficient financial support from in-terested
groups, foundations and in-dividuals
to implement the program
for a period of three years—from
early 1963 through 1965. The pro-gram
was set up to be financed and
operated through the North Carolina
Hospital Education and Research
Foundation, Inc., a nonprofit, char-itable
and educational foundation.
After the three-year period speci-fied,
the program had shown a prom-ising
increase in the number of young
persons entering the health field. A
survey which was completed in Janu-ary,
1965, revealed an increase of 36
percent in the number of applica-tions
to health-related schools in 1964
over the number in 1963. Twenty per
cent more students were accepted as
being qualified in 1964 over the num-ber
accepted in 1963.
Since the need for skilled persons
in the medical and paramedical pro-fessions
remains critical in spite of
the success of the first three years,
a concentrated recruitment program
will continue until the need is met.
The Board of Trustees of the North
Carolina Hospital Association, acting
upon the recommendation of the 14-
member Health Careers Council,
therefore voted unanimously to con-tinue
the Health Careers program
for a second three-year period
through 1968.
Seek Young People
The success of the Health Careers
program is dependent upon the effect
it has upon the young students who
come under its influence and, as a
consequence, decide to enter a career
in the health field. To accomplish this
goal of informing and assisting stu-dents
in the selection of a health
career, a 14-member, full-time staff
is distributed throughout the six dis-tricts
into which North Carolina has
been divided. Included on the staff is
the Director of Health Careers, who,
aided by his secretary, coordinates
the activities of the separate dis-tricts
at the state level. A district
coordinator and secretary operate ex-tensively
in each of the six districts.
The effectiveness of the program
depends to a large degree upon the
presentation of well-directed, inter-esting
programs by the coordinators.
Each presentation, aimed at appeal-ing
to particular students in a spe-cific
area, must be custom-planned.
The coordinators work directly with
the students in junior and senior high
schools, as well as with students in
junior colleges and professional soci-eties.
Special presentations are made
to these students in general assem-bly
programs and to those in various
select youth groups, such as Intro-duction
to Vocations, Industrial Co-operative
Training, Health Occupa-tions
classes, Health Career Clubs
and Candy Stripers.
ESC QUARTERLY
The photographs here illustrate only a few
of the health service occupations now
experiencing shortages of qualified per-sonnel,
and occupations Health Careers
hopes to see filled through its efforts to
guide young people into medical careers.
Presented to Students
The presentation given at student
assembly programs usually features
a short talk on health careers by the
coordinator; this talk is followed by
either an appropriate movie such as
"Look Towards Tomorrow" or slides.
The film "Look Towards Tomorrow"
was especially prepared for Health
Careers. Other movies, such as "But
for These" and "Helping Hands for
Julie" are sent out from district offi-ces
to health occupation classes.
After the assembly presentation,
the coordinator has postcards distrib-uted
in order that the students may
easily request additional information
on special careers in health. A wide
variety of brochures and other print-ed
materials are available for send-ing
to the students upon receiving
their requests. An offer to arrange
an interview for the student with a
Skilled laboratory technicians are in short
supply. Both public and private medical
institutions need personnel of this type to
perform medically related testing and
analysis. Health Careers is a statewide
program to inform students of the oppor-tunities
and training needed to fill medical
and health jobs.
professional consultant in the area
of his or her interest is made by the
coordinator.
The cooperation of interested pro-fessional
persons in conducting these
personal interviews, as well as ar-ranging
tours of medical facilities,
has done much to strengthen the suc-cess
of the Health Careers program
in North Carolina. Such personal con-tacts
between the student and the
professional person, especially in his
work environment, can increase the
student's interest and strengthen his
determination to enter health.
Health Careers has made available
many aids for the use of coordinators
to increase the effective implementa-tion
of the total program. Wanting
to inform students fully of career
opportunities in health, the program
has compiled its own directory of
health careers—Health Careers Guide-book.
A copy of this guidebook, the
successor to the earlier Health Ca-reers
for Tar Heels, has been dis-tributed
to all high schools in the
state so that students may easily re-fer
to it.
A Health Careers Scholarship Man-ual
has also been published for dis-tribution
to guidance personnel and
other professional groups throughout
the state. This 75-page manual is an
invaluable aid for qualified students,
especially those in need of financial
assistance, planning to enter a health-related
school.
The Health Careers program spon-sors
annually a statewide Health Ca-reers
Congress in February. Only
members of chartered Health Ca-reers
Clubs may attend. The Fifth
Annual Congress was held in Raleigh
in 1966. Several hours were given to
professional consultation between the
students and representatives of dif-ferent
health professions.
School Clubs
Each district has its own Health
Careers Day. Club members prepare
exhibits for display at the fair. All
interested students are urged to at-tend
this health fair.
The coordinators devote a great
Tedious skill, fulfillment of a surgical
career begun perhaps 10 years earlier.
Physicians needed in 1976 must have
the desire today.
8 ESC QUARTERLY
deal of time to the promotion and
assistance of Health Careers Clubs
in the schools within their districts,
rhese clubs bring together students
interested in careers in nursing and
Dther health-related fields in order
to explore the opportunities and re-quirements
in the various health ca-reers.
A school advisor works directly
with the club. He also works closely
with the school personnel, especially
the guidance counselor, to insure that
;lub members receive complete and
jp-to-date information. A commu-nity
sponsor, representing community
interests, is a great aid in securing
jxperts in nursing and other health-related
professions as speakers,
quests or consultants. Such resource
oersons as these are available to pre-sent
interesting club programs on the
mportunities, requirements, advan-ces
and satisfaction of pursuing a
career in health.
The clubs throughout the state, now
lumbering over 150, have organized
themselves as Health Careers Clubs
)f North Carolina. The director and
:oordinators serve on their executive
:ommittee. Club members are elected
;o fill the state offices. This organi-sation
of the students tends to stim-ilate
greater interest among them
n promoting the organization of ad-litional
clubs, planning more inter-ring
programs and encouraging
nembership.
The program emphasizes that a
variety of methods can be utilized to
ittract the interest of young persons
n the possibility of a career in
lealth. Open houses can be sponsored
>y professional schools in order to
illow students to receive first-hand
nformation and impressions of the
ollege facilities and courses offered,
hospitals are encouraged to have
ipen houses giving a view of the
iractical applications of a career in
. hospital.
Career-oriented work experience
nth a health practitioner, such as
)andy Striper programs in hospitals,
re beneficial to young persons inter-sted
in a health career.
Health Careers for North Carolina
s a growing, vital program, changing
o meet the need of North Carolina
tudents. Staff members continuously
eek any improvements which they
an make in the program. The coor-inators
attend periodic workshops
yhich are planned by the director,
'hese workshops provide them with
he opportunity to exchange ideas
nd re-evaluate programming tech-iques.
As long as the crucial short-ge
of health personnel exists in the
tate, Health Careers will strive to
eep abreast of the ever-expanding
ealth field and be aware of the im-ortance
of tailoring the program to
t the needs of the time.
The
ke Endowment
The philanthropy of the Duke En-dowment
extends to four areas of
service—health, education, child care,
and religion.
In planning the Endowment, which
was established on December 11, 1924,
James B. Duke selected hospitals in
his native North Carolina and in
South Carolina as major beneficiaries
because he considered them indispen-sable
institutions for "increasing the
efficiency of mankind and prolonging
human life." He described their facili-ties
as "essential for obtaining the
best results in the practice of medi-cine
and surgery" and expressed the
hope "that the people will see to it
that adequate and convenient hospi-tals
are assured in their respective
communities, with special reference
to those who are unable to defray
such expenses of their own."
Mr. Duke died on October 10, 1925,
before the Endowment was a year
old. In his will he left, among other
bequests, $4 million for building and
equipping a medical school, a hospital,
and a school of nursing at Duke
University. The provision for these
schools was an indication of Mr.
Duke's understanding of health care
needs at that time and of his fore-sight,
for the shortage of persons
trained to serve the sick has developed
into an extremely critical problem.
$234.5 Million
In the Endowment Indenture, Mr.
Duke set forth terms under which
available funds were to be distri-buted.
Those given for health help
hospitals finance charity services,
assist in the building, equipping, and
purchase of hospitals, and make pos-sible
improved health care through
special projects designed for this
purpose. These allocations and appro-priations,
which had amounted to
more than $53.5 million at the end
of 1965, the forty-first year of the
Endowment, have had a tremendous
impact on the adequacy and quality
of health care in the Carolinas and
also on the economic progress of the
area. Add to these the sums provided
for the four beneficiary educational
institutions, child care institutions,
and religious causes, the total is more
than $234.5 million. This averages
nearly $5,720,000 a year channeled
into four areas of service to mankind.
While the financial contribution of
the Endowment is important in it-self,
it is in what the Endowment
has encouraged and helped the people
of the Carolinas to do for themselves
that its greatest value lies. This can
be illustrated by remembering a 1924
study of N. C. hospitals made by
Dr. W. S. Rankin, director of the
Hospital and Orphan sections of the
Endowment for 25 years and now
Trustee Emeritus and a consultant to
these sections, which revealed that
44 of North Carolina's 100 counties
had no short-term general or special
hospital beds and that in the whole
State there were only 1.5 beds for
each 1,000 persons. By 1964 all ex-cept
16 of North Carolina's counties
had such facilities and there were
3.4 beds for each 1,000 of the popu-lation,
which compares favorably
with the national figure of 3.6 beds.
Determining Factor
Through these years of progress,
funds of the Duke Endowment to
help finance hospital facilities have
had a part in making it possible for
thousands to have medical care which
they otherwise might have been de-nied.
This is true because hospital
beds convenient to most of the popu-lation
have been provided and be-cause
the presence of a growing
number of hospitals, the improved
facilities, and the availability of
nurses and technicians have caused
many physicians to settle in com-
ESC QUARTERLY
Bachracli Bachracl
JAMES R. FELTS, JR.
Hospital and Child Care Section
paratively small communities when
they would not have considered doing
so without these advantages.
With the help of Duke Endowment
contributions, complete hospitals have
been built where there were none,
additional beds and equipment have
been made possible at existing insti-tutions,
and services have been ex-panded
and improved. In some cases,
privately owned hospitals have been
purchased and replaced by modern,
nonprofit community institutions. At
times, funds of the Endowment have
made up the difference between the
money on hand from other sources
and the cost of the proposed projects,
thus becoming the determining fac-tor
in providing complete new hospi-tals
or more adequate facilities and
services in institutions already in
operation.
Concern of the Trustees of the
Endowment for charity care and ade-quate
facilities is accompanied by
active interest in helping to increase
the number of physicians, nurses,
and technicians, to improve the ef-fectiveness
of graduate medical edu-cation,
to increase outpatient services,
to attract more doctors to general
practice, to provide facilities for the
care of the age and the chronically
ill long-term patients, and to bring
improvement wherever it is needed
in the care of the sick.
In North Carolina where a study
conducted by the Endowment in 1962
showed an alarming shortage in
medical and paramedical personnel,
the foundation helps to support a
statewide program, Health Careers
for North Carolina, which was initi-ated
by the North Carolina Hospital
Association to attract qualified young
people to health careers. The pro-gram
began in 1963 and an almost
immediate result was that in 1964
applications to health related schools
were 36 per cent greater than in
1963 and admissions to these schools
were 20 per cent greater. The pro-gram,
which is administered by the
Education and Research Foundation
of the North Carolina Hospital Asso-ciation,
is in its fourth year. When
it was begun, the estimated need of
nurses, technicians, and others for
health service positions was 4,817. In
spite of the excellent accomplish-ments,
the need continues to be very
large, for the growth in population,
the increase in services available for
the care of the sick, the broader par-ticipation
in hospitalization insurance
plans, and the coming of Medicare
have brought new and greater de-mands
for people to serve the mount-ing
number of patients. At a time
when hospitals are operating at capa-city
and more beds are needed des-perately,
there are facilities in the
State which cannot be used because
the hospitals are unable to obtain the
staff necessary to operate them.
In another program to create in-terest
in health careers, the Endow-ment
joined the State Board of
Education in paying the cost of a
study of nursing education in North
Carolina which was sponsored by the
North Carolina Board of Higher Ed-pr?
IK.
MARSHALL I. PICKENS
Vice Chairman, The Duke Endowment
ucation, the State Board of Educa-tion,
and the North Carolina Medical
Care Commission. The report of the
study by Dr. Ray E. Brown, director
of the General Program in Hospital
Administration at Duke University,
was published in 1964. It included
information on the need for and edu-cation
of nurses in the State and
described the key role which institu-tions
of higher learning, including
community colleges, must play in
meeting the needs for well-trained
nurses at all levels.
General Practitioners Needed
Because so many physicians go into
specialties or research and settle in
the large population centers, the num-ber
in general practice and serving
in community hospitals is insufficient.
Hoping to interest young doctors
to enter general practice in rural
communities, the Endowment has
financed since 1961 a Community In-tern
program for junior and senior
medical students. Some 70 of these
young people spend two months in
the summer as junior interns in par-ticipating
hospitals, gaining experi-
I s»
Illustrative of the work done in the training ot interns, residents, and junior interns in several North Carolina hospitals are these photographs which
were made at the Charlotte Memorial Hospital showing daily teaching rounds (left) and routine daily rounds. The Endowment has financed a
community intern program.
10 ESC QUARTERLY
)nce and knowledge related to general
)ractice and learning of the oppor-unities
it offers. It is essential to
ittract more doctors to this type of
>ractice. Figures from the American
Vledical Association showed that in
.964 North Carolina, with 4,533
)hysicians in active practice, had
•nly 1,303 physicians, or one for each
1,274 of the population, engaging in
general practice.
Another Endowment project di-ected
toward increasing the number
if physicians in general practice was
i forum held at the Duke University
Medical Center in May, 1964, which
vas attended by more than 100 stu-lents
and faculty members. Leaders
n medical education and physicians
trominent in general practice were
peakers.
Graduate medical education is, of
ourse, a most important part of the
raining of a doctor. In recent years
he Endowment has made appropri-ations
to help a number of hospitals
n the State establish Departments
f Medical Education which, in addi-ion
to training their own interns
ind residents, demonstrate to other
lospitals what can be done to make
in educational program most effec-ive.
The success of a hospital in ful-illing
its responsibilities depends in
i large measure upon the abilities
f its administrator. Cooperating
rith Duke University in a program
f Hospital Administration since the
arly 1930s, the Endowment has
ontributed to the training of nearly
00 students who are active in hospi-al
or related fields. Most of these
tudents served administrative resi-lences
with the Endowment. Also,
n the year beginning with 1930, the
Endowment has had assigned to its
Charlotte office more than 200 ad-ninistrative
residents or trainees who
have received one week or more of
orientation, field work, or experi-ence.
Most of these are active in
hospital or related fields.
Since the forum on general prac-tice
was held in 1964, there have been
two others, one on the problems of
multiple-unit hospitals in 1965 and
one on outpatient services in May,
1966. These forums are considered
highly valuable as opportunities for
hospital administrators to- gain
knowledge on subjects of importance
to their work and to exchange ideas
with others who have similar in-terests.
Activities of the Endowment are
directed by its Trustees of whom
Thomas L. Perkins is chairman. Of-fices
are in New York, Charlotte, and
Durham. Centered in the Charlotte
office, which is under the general
supervision of Marshall I. Pickens,
are services to hospitals and child
care institutions. Mr. Pickens is vice
chairman of the Endowment and
has been a Trustee since 1951. With
the Endowment since 1928, he was
executive director of the Hospital
and Child Care sections for 16 years.
Early this year, he relinquished this
office and was succeeded by the assist-ant
executive director, James R.
Felts, Jr., who has been with the
foundation for 23 years.
The staff of the Hospital Section
counsels trustees and executives of
institutions who wish advice on mat-ters
connected with administration,
accounting, new or expanded facili-ties,
or services. Several years ago
it developed a uniform record-keeping
system which enables hospitals to
analyze costs and establish rates, and
for many years it has compiled and
distributed statistical information
which helps administrators evaluate
their own operations by comparing
them with those of other similar in-stitutions.
It often has been said by
administrators that staff services are
more valuable to them than the
money they receive from the En-dowment.
North Carolina hospitals are in a
period of change as they become in-creasingly
important as the health
centers of their communities and face
new demands and growing responsi-bilities.
In this period, as in all the
years since the Endowment was
established, they have the advantage
of being able to benefit from the
knowledge and experience of their
benefactor as well as from its finan-cial
assistance. Because Trustees of
the Duke Endowment have great
concern for the improvement of
health care in the Carolinas, they
combine a program of services with
distribution of financial help and, as
a result, the Endowment is a major
factor in the development of more
adequate facilities for the care of the
sick in the two states it serves.
The ESC Quarterly is
printed in four volumes,
published twice a year.
It is printed under state
contract by the Print Shop,
N. C. State University,
Raleigh, N. C.
i
'&-W
Ski
t the Charlotte Memorial Hospital a teaching member of the visiting medical staff meets with the Pediatrics house staff (left), and an intern and
Jnior intern receive instruction from a teaching member of the attending staff in the Department of Pediatrics.
ESC QUARTERLY 11
M
V@oa
wmws
Ml
Submitted by the
STATE BOARD OF HEALTH
12 ESC QUARTERLY
H,ealth personnel is in short supply.
This is true whether you have in
nind doctors, nurses, health educa-tors,
sanitary engineers, dentists, pub-ic
health nurses or any of the scores
)f health and health related profes-sions.
And the critical situation we face
low in North Carolina and in the
lation will get worse before it gets
setter. Without getting lost in statis-ts,
let's look at the problem.
The situation will get worse for
several inescapable reasons. First of
ill, the population is increasing in
jercentage more rapidly than the
jercent increase in health personnel.
Population increases are greater in
rounger age brackets and in the
)racket above 65 years, the two
groups needing proportionately more
lealth services.
Another reason for the critical
ihortages in health personnel is the
greater expectation of the people for
lealth services. The people hear of
;he amazing day-by-day advances in
nedicine and science, and they want
;he health benefits and want them
tow.
Still another pressure put upon the
jresently available health personnel
s the capacity for training of the
)resent institutions for preparing
ioctors, dentists, public health work-ers,
nurses and the others. These in-stitutions,
like Rome, were not built
n a day, nor were they built without
jreat expenditures of funds. And the
:'unds were not secured without
nonths and even years of considera-
;ion and effort, whether those funds
:ame from private or public sources.
In North Carolina, if an institution
—medical, nursing, public health or
lommunity college—is to receive pub-ic
funds, these funds have to be
luthorized by the General Assembly
vhich meets only every two years,
^nd, once authorized, it takes several
'ears to build any major physical
'acilities, and then the problem of
inding staff members is really faced,
t is not sufficient to merely take
itaff from other institutions which
rain health personnel. This maneu-rer
does not increase the supply of
lealth personnel. So you can see what
he problem is, at least in part.
Multi-Duties
In the health professions, we have
ittle difficulty getting people to take
•rofessional training if we have the
eats in training institutions where
hey can become prepared. We need
nore seats and the teaching staff to
nstruct the students.
Another aspect of the health man-
>ower shortage is the fact that pres-et
manpower is not being used effi-
Medicol personnel of far ranging abilities are needed to man today's modern and fully
equipped intensive care unit (above) and operating room. Note the scrupulous instruments
and technical devices, all requiring the knowledgeable touch of the competent physician,
anesthesiologist, nurse—professions which need intensive training and continuing study.
Dr. Jacob Koomen became Director
of the State Board of Health in May,
1966, succeeding Dr. J. W. R. Norton
who, after 17'/z years, resigned this
position due to ill health.
A graduate of the University of
Rochester School of Medicine, Dr.
Koomen is a native of Bristol, New
York, and was an instructor in
KOOMEN
medicine and bacteriology and assist-ant
physician at the University and
Strong Hospital for five years.
In 1954, Dr. Koomen was assigned
to the N. C. State Board of Health
by the Epidemic Intelligence Service
of the U. S. Public Health Service.
A surgeon, Dr. Koomen subsequently
became Director of Epidemiology for
the State Board of Health, and in
1957 received his Master's degree in
Public Health from the UNC School
of Public Health.
In 1961 he became Assistant Direc-tor
of the Board of Health.
Active in many public health activ-ities,
Dr. Koomen received the
Reynolds Award in 1960 for outstand-ing
contribution in public health in
North Carolina, and holds member-ship
in several national and state
professional associations.
He is the author and co-author of a
number of publications in the field of
epidemiology and holds the rank of
Senior Surgeon (R) in the U. S.
Public Health Service. He is currently
Visiting Associate Professor at the
UNC School of Public Health.
ESC QUARTERLY 13
Job completed! Happy it's over, this young man has had proper
dental care. Dentistry is another medical profession facing shortages
of qualified dental assistants (left) and doctors of dentistry.
In some remote areas of North Carolina, medical services are sparse. Medical
facilities are vitally needed by minority groups, such as this young Indian child
suffering with severe diarrheal disease.
Rehabilitation is a vital service of the medical profession. A public health nurse (left) works
with an elderly stroke victim. Other services are more technical, such as the audiometer
test being given to determine the child's range of hearing (right).
14 ESC QUARTERLY-ciently.
Doctors are having to do
administrative and other tasks in
addition to providing the medical ser-vices
for which they have been spe-cifically
trained. Dentists are similar-ly
burdened. Hospital nurses and
public health nurses and other health
personnel have the same problem.
The introduction of nurses aides
and technicians in many other health
fields to have some of these tasks
assigned to them under professional
supervision is becoming one way of
more efficiently using the present
health manpower. The training of
such aides and health technicians is
a new and important field of endeavor
for the community colleges, and even
to train these aides will take two or
more years after you get the institu-tion
built and staffed.
Too Few
Until now we have not mentioned
Medicare but this massive program
must be absorbed and made to work
with too little time, too few health
facilities and training institutions and
too few trained people to do the job.
With all its acknowledged benefits,
such government action could dilute
the excellence of the present medical,
hospital and other health care which
present facilities and health person-nel
can deliver.
This point is an immediate concern
of some medical leaders. Lowell T.
Coggeshall, MD, Vice President of
the University of Chicago and Chair
man of the panel on Medical Educa
tion at last November's White House
Conference on Health, had this tc
say: "There is a critical manpowei
shortage at all levels." He said the
solution is an adequately trained sup
ply of manpower, even though th(
nation will have to accept the fac
that it can never have enough physi
cians. "Nevertheless," he insisted
"we must increase the number of med
ical schools and increase their size
There is some apprehension that i:j
we aren't careful . . . Congress wil
put laws on the books before we cai
provide the manpower to carry ou
the programs. If that happens, thei
the alternative is crash programs, ant
they are always ill advised and usual
ly poorly conceived."
N. C. Activities
What is North Carolina doing abou
increasing the supply of health man
power?
Every health profession has a re
cruitment program in operation wit
varying results, competing as the
must with other professions and voca
tions, health and non-health related
The activities and contributions o
Health Careers for North Carolins
Inc., is long range and constructiv
nd even now is producing an upward
urn in the recruitment picture.
Health training institutions and
gencies are maintaining standards
nd assuming their share of the re-ponsibility
to provide health man-ower
trained and in sufficient num-ers
to meet our State's need and
lake our proper contribution to the
eeds of the nation.
In summary, the American people
re demanding more and better health
ervices. They want the benefits of
lodern science for the promotion of
ealth and the care of the sick.
We need to take an overview of
ealth manpower involving all the
ealth professions and occupations of
11 levels of skill. This should include
ot only traditional jobs that have
een denned by long experience but
he emerging, new roles and positions
i the developing programs of health
ervice.
The main concern in health man-ower
is not merely to rearrange the
resent health manpower pool, but
3 materially enlarge it.
The pressure of need under which
;e have labored for years has been
ubstantially augmented by recent
evelopments, particularly the ex-anded
health care for the aged which
lready has had tremendous implica-ions
for manpower.
President Johnson in "Advancing
he Nation's Health," his message to
he 89th Congress January 7, 1965,
aid "We must . . . look to the future
i planning to meet the health man-ower
requirements of the Nation.
"Unmet health needs are already
irge. American families are demand-lg
and expecting more and better
ealth services. ... If we are to meet
ur future needs and raise the health
f the Nation, we must improve utili-ation
of available professional health
ersonnel; expand the use and train-ig
of technicians and ancillary
ealth workers through special
chools and under the Vocational
Education Act and Manpower De-elopment
and Training programs;
xpand and improve training pro-rams
for professional and for sup-orting
health personnel; plan ahead
d meet requirements for which the
?ad time is often 10 years or more."
North Carolina must face up to
his critical and urgent problem and
reate and improve and enlist facili-ies,
institutions, training programs,
nd personnel until adequate and
igh quality health care is available
3 all our citizens.
Who will keep you well if we have
ao few trained people to meet the
ealth needs of our growing, expand-ng
population?
Counselor, doctor, hygienist—often the public health nurse is the
only contact some residents of mountain counties have with health
services. Administering to both young and old, the touring public
health nurse demonstrates a dedication very few medical service
workers exceed.
The ink blot test, an invaluable aid to mental health, is given a
youngster by a psychiatric worker. Community mental health centers
and other special programs demand a large number of dedicated
workers and already shortages exist in personnel to administer new
methods of mental health.
The general practitioner, foundation of community medical services encounter ever in-creasing
appointments attempting to communicate between hospital and hospital.
Laboratory technicians (right) are highly trained personnel necessary for the continuing
search for and identification of disease.
ESC QUARTERLY 15
The Moses H. Cone Hospital in Greensboro opened in 1953. Presently there are 17 de-partments
within the Hospital and employment is approximately 750 people in over 100
different occupations.
MOSES CONE OFFERS SPECIALIZED TRAINING
TO MEDICAL AND HOSPITAL PERSONNEL
By Stella Jones
The Moses H. Cone Memorial Hos-pital,
Greensboro, North Carolina, is
a 424-bed, short-term, non-profit, vol-untary
hospital. Its services range in
scope from the Intensive Care Unit
for patients acutely ill to the Pro-gressive
Care Unit for patients who
require the minimal amount of
attention.
The hospital was established in
1911 as a memorial to Mr. Moses H.
Cone by his wife, Bertha Lindau
Cone. Actual construction was not
begun until many years later, and it
was February 25, 1953, before the
hospital opened its doors for the first
time. Since 1953 the hospital has
grown in size and in the scope of
services provided. It is one of the most
well equipped community facilities in
the state.
Renovation of the laboratory has
just been completed at a cost of ap-proximately
$600,000. This more than
doubles the previous amount of floor
space and greatly increases the labo-ratory
services available. The radiol-ogy
department houses a cobalt
therapy unit for the treatment of
cancer and other tumors. Equipment
has been ordered for the installation
of a cardiopulmonary laboratory to
be used in extensive diagnoses of
heart patients. These are but a few
of the steps taken and being taken
at Moses Cone Hospital in order to
keep abreast of the rapid changes in
medicine today.
In all there are 17 departments of
the hospital. Each serves a vital
function in relation to the operation
of the whole hospital. It takes ap-proximately
two and one-half em-ployees
per patient to keep the hospi-tal
running smoothly. This figure
means that there are about 750 em-ployees
filling approximately 100 dif-ferent
job classifications. The oppor-tunities
are great, for such a variety
of jobs insures a variety of people
and a variety of necessary skills.
There is a place for a highly trained
professional and there is also a place
for the person with little formal edu-cation.
Some of the jobs offer training
programs, and Moses Cone Hospital
employs three full-time, in-service
education instructors for this purpose.
This means that in order to fill many
of the hospital positions available
you need not have had any experience
in that type work.
Many Job Opportunities
There is always the much publi-cized
need for nurses. There is, in
addition, a need for persons to fill
jobs such as orderlies, kitchen police,
porters, tray girls, etc. There are jobs
for men and women. Age is no real
deterrent, for the various job classifi-cations
require different aged people.
Employees ranging in age from 18 to
76 years are employed at Moses Cone
Hospital. There are handicapped em-ployees
who are performing their
jobs and performing them well. There
is also a place in the hospital for ex-servicemen,
who by nature of their
military training have acquired valu-able
skills.
The advantages of working in a
hospital are many. Since hospitals are
necessary to the community there is
little chance of suffering a reduction
of the work load with its ensuing
"lay-off." Moses Cone Hospital takes
every precaution to see that its em-ployees
are physically fit for their
jobs. Prior to employment and each
subsequent year, employees are re-quired
to have a serological test and
a chest X-ray. Group hospitalization
and life insurance is available at a
low premium. The salary, sick leave,
vacations and working conditions are
excellent.
Moses Cone Hospital also serves as
a teaching institution, for students
from UNC-G receive their practical
experience in the hospital under close
supervision. Likewise, practical nurs-ing
students from Guilford Technical
Institute also take their practical
training at Moses Cone Hospital. A
similar affiliation is also maintained
with the A & T College School of
Nursing. In addition to these affilia-tions,
Moses Cone Hospital itself of-fers
three schools.
The School of Medical Technol-ogists
operated by the laboratory pro-vides
a one-year course of academic
training with actual work in the lab
where more than 200,000 tests and
analyses are performed each year.
There is also a School for X-Ray
Technicians which accepts a limited
number of graduates from accredited
high schools for a specialized 24-
month training course. Last August a
class for Operating Room Techni-cians
(O.R.T.'s) was established for
graduates of approved schools ofj
practical nursing who desire further}
training in operating room technique.
j
It is hoped that these classes will
help to relieve the shortage of quali-fied
operating room personnel.
Volunteers
In addition to its employees, Moses
Cone Hospital has a vital link with
the community through its volunteer
workers. During the past year a totalj
of 21,104 hours was contributed byj
the volunteers. Of this figure, 12,000
hours were contributed by the Candy
Stripers and Pilots who are the teen
age volunteers.
(See MOSES CONE, page 33)
16 ESC QUARTERLY
Patients Entering Hospitals Today
Have New Prospect of Recovery As
Public and Profession Alike Adopt
New Philosophy Toward Mentally 111
MENTAL HEALTH
By Dr. Eugene A. Hargrove
Commissioner, N. C. Department of Mental Health
Persons choosing a mental health
career today are entering a field of
work that is dynamic and full of
hope and challenge.
This has not always been so.
For a century, beginning with the
establishment in 1856 of the first
State mental hospital in North Caro-lina,
the care of the mentally ill was
a discouraging problem of ever-mounting
patient populations. In the
absence of really effective treatment
methods, patients remained in the
hospitals indefinitely and the accumu-lation
led to overcrowding and a con-tinuing
demand for new buildings and
more beds.
The development of new treatment
methods, particularly the psychotro-pic
drugs, brought about a dramatic
reversal of the established trend
toward rising hospital populations
when in 1956 the total declined
slightly for the first time in history.
The realization that mental illness
can be successfully treated has
brought many more North Carolin-ians
to the state hospitals for treat-ment,
an increasing number of
voluntary admissions. Admissions to
the four hospitals during 1964-65,
for example, totalled 12,561 as com-pared
to only 4,270 patients during
1956-57—an increase of almost 200
percent in eight years.
During the same eight year period
the average daily resident popula-tion
of the four hospitals dropped by
almost 1,000 patients. Patients are
being discharged to their homes and
communities at a faster rate than
they are being admitted.
Bygone Philosophy
Patients entering our mental hos-pitals
today have a new prospect
over the "abandon hope" philosophy
of years ago. No longer need they
be resigned to interminable years of
residence there. In 1962, for example,
58 percent of patients discharged had
hospital stays of two months or less.
By 1964, 75 percent could expect to
leave within two months. Currently
the median length of stay is 32 days.
The state psychiatric hospital of
today is no longer the institution it
once was, a haven or asylum of cus-todial
care which served to isolate
and segregate the mentally ill from
the eyes and consciences of society.
Today our State hospitals have
an entirely different role. The modern
psychiatric facility in North Carolina
is a treatment-oriented medical facili-ty
whose well trained professional
staff offers intensive therapy for both
acute and chronic patients, special-ized
services for groups with special
problems and a comprehensive pro-gram
of rehabilitation services. It is
becoming increasingly a part of the
community, moving into an ever closer
relationship with the homes of the
people it serves. No longer an iso-lated
"human warehouse" of custo-
ESC QUARTERLY 17
The 1963 General Assembly passed
an act creating a State Department
of Mental Health and a State Board
of Mental Health. The new Depart-ment
was given the responsibility
,
under medical leadership, for co-ordinating
and directing all mental
health programs and facilities in the
State, including local community
mental health centers and clinics, four
regional state mental hospitals and
four residential centers for mentally
retarded, and special programs for
alcoholics, emotionally disturbed chil-dren,
and mentally ill inmates of the
State Prisons system. Certain licens-ing
responsibilities are also included.
At the State level in the central
office of the Department eight ad-ministrative
positions are established
by law. They include the positions of
commissioner of mental health, gen-eral
business manager and five deputy
directors. One deputy director has
responsibility for all retardation pro-grams,
including the four residential
centers as well as community pro-grams.
A deputy director serves each
of four mental health regions of the
State: western, north central, south
central and eastern, each containing
a regional mental hospital and a
number of community mental health
programs.
The cotnmissioner of mental health
also administers programs in profes-sional
education and training, re-search,
statistics, mental health edu-cation,
professional services and plan-ning.
dial care, it is developing into a
dynamic link in a network of in-patient
and outpatient services
which seeks to provide a program
of continuous, comprehensive psychia-tric
care when and where it is needed.
For Mentally Retarded
In addition to the mental hospitals,
the North Carolina Department of
Mental Health operates four resi-dential
centers for the mentally re-tarded
located in Morganton, Butner,
Kinston and Goldsboro.
Mental retardation is a deficiency
of intellectual capacity usually pres-ent
at birth and often associated
with severe physical disability. It is
a problem different in many ways
from mental illness and with few ex-ceptions
is not reversible, even with
the most intensive treatment. For
this reason the encouraging increase
in discharges and reduction of patient
population which has occurred in the
mental hospitals has not taken place
in the State centers for retarded.
Since 1962, for example, an in-crease
of 50 percent in patients under
care in the State centers for re-tarded
has been noted. Much of this
increase is attributable to additional
beds. Western Carolina Center in
Morganton, with 600 beds, opened in
1963. Several new cottages were built
at O'Berry Center in Goldsboro.
In the retardation centers, admis-sions
are rising, discharges are not
keeping pace and the retarded popu-lation
is therefore growing. That
there is still an unmet need for resi-dential
care is evidenced by sizeable
waiting lists which exist at all of the
State's centers.
As North Carolina communities are
able to develop more resources, such
as special education classes, sheltered
workshops, rehabilitation houses, and
day care centers, it is expected that
more and more of our mildly retarded
children will be able to remain at
home. However, normal growth of
the general population along with de-creased
infant mortality is bringing
increasing numbers of severely re-tarded
and multiply handicapped
children into the State centers. In
response the four facilities will in-creasingly
become centers for long
term intensive care of the severely
handicapped. There will at the same
time be fewer of the mildly and mod-erately
retarded, who have a better
chance of returning to the community.
But even in working with the
severely handicapped, the staffs of the
centers reject a custodial philosophy
of care. There is a growing emphasis
on rehabilitation, education and train-ing
within the limits of each retarded
resident's capacity. Dedicated staff
personnel work with a sense of pur-pose
and an air of optimism. The ob-jective
of North Carolina's mental
retardation centers is to help each
individual resident develop to his
maximum capacity and to become as
happy and as self-sufficient as his
handicaps will allow.
Remarkable Growth
Accompanying the expansion of
services to the hospitalized mentally
ill and retarded has been the rapid
growth and expansion of mental
health services through the community
mental health clinics.
At present, 34 community mental
health clinics and 17 satellite pro-grams
provide service coverage to 51
counties in the state. Considering that
at the close of 1961 there were only
12 clinics and 11 satellite programs,
this is a remarkable rate of growth.
Patients under care in the mental
health clinics totalled more than
22,000 during fiscal 1965, compared
with only 8,356 patients seen in the
clinics during 1962.
The Department of Mental Health
is committed under its Comprehensive
Mental Health Plan to participate
with Federal and local governments
in constructing new comprehensive
mental health centers in 27 areas of
the State, each comprising a popula-tion
base of between 75,000 and
200,000 people. This expansion is
projected over a period of several
years, but will eventually require the
services of scores of additional trained
personnel, particularly psychiatrists,
social workers, psychologists and
mental health nurses.
The community mental health center
is staffed by psychiatrists, psychol-ogists
and social workers, each
contributing his unique skills within
the context of the "team approach."
Typically a psychiatrist serves as
director of the center and assumes
medical responsibility for the diag-nostic
and treatment services afforded.
The psychiatric social worker assumes
responsibility for coordination with
other community agencies and pro-vides
the social history for the
patient. The clinical psychologist
administers intelligence tests and pro-jective
techniques of personality
evaluation as indicated. All team
members in conference with each
other and with representatives of
allied agencies when appropriate,
arrive at a diagnosis and treatment
recommendation. The patient is then
assigned to a member of the team
for treatment, while family members
Of the more than 10,000 patients dis-charged
from State hospitals last year,
many are referred to the outpatient clinic
for followup care and maintenance of drug
dosage. Inpatient and outpatient services
provide continuous phychiatric care.
18 ESC QUARTERLY
ire counseled by another worker.
\iter certain treatment objectives
ire reached, referral of the patient to
mother agency may be made.
In addition to direct services to
jatients, the centers increasingly of-fer
consultation to other professional
lisciplines who meet with mental
lealth problems in their professional
pursuits and who can be helped to
leal more effectively with this aspect
>f their work. Among the principal
groups using mental health consul-
;ation are teachers, general practition-ers,
public health nurses, and welfare
:aseworkers.
Further indirect service to adults
md children is offered by community
nental health personnel in the pro-vision
of information and education
services to the general public and
nservice training for professional
groups. Thousands of hours of pro-fessional
time is devoted to these
;hree major types of community
services by mental health center
workers, in addition to their treat-nent
function.
More Personnel Needed
To carry on all the far ranging
work of the Department of Mental
Health—operation of the State hos-pitals,
the centers for retarded, com-munity
mental health centers, and
)ther special programs—demands a
arge and dedicated corps of person-
HARGROVE
When the Department of Mental
Health was established in 1963, Dr.
Eugene A. Hargrove, who had been
director of the Hospital Board of
Control since 1958, was appointed
Commissioner of the new State
agency.
A clinical professor of psychiatry
at the University of North Carolina,
Dr. Hargrove holds AB and MD
degrees from the University of Texas.
He performed his internship at the
General Hospital in Denver, Colorado
and his residency in psychiatry at the
Clarkson Hospital, Omaha, Nebraska.
From 1947-48 Dr. Hargrove was a
Fellow in Psychiatry at the Institute
of Nervous and Mental Diseases in
Philadelphia and at the University
of Pennsylvania from 1948-50.
He was certified as a Diplomate by
the American Board of Psychiatry
and Neurology in 1950.
The Mental Health Commissioner
has had teaching experience at the
schools of medicine at the universities
of Pennsylvania, California and
North Carolina.
Member of nearly a dozen profes-sional
associations and organizations,
Dr. Hargrove served in the Army
Medical Corps during World War II.
He is author of a book, "The Practice
of Psychiatry in General Hospitals,"
and numerous papers on psychiatric
studies.
Psychiatric nursing affiliations exist in
each of the State psychiatric hospitals,
allowing undergraduate student nurses from
hospital nursing schools statewide to re-ceive
part of their training in a psychiatric
setting. For physicians, fully approved
three-year residency programs are in op-eration
in two psychiatric hospitals.
nel. We are fortunate in that our
personnel possess the required dedi-cation
in liberal measure. But even
though we currently employ roughly
6,800 persons in all phases of mental
health work, a great many more
personnel are needed, particularly
those directly responsible for patient
care and treatment.
In the psychiatric hospitals, for
example, we are setting as a goal
the achievement of full accreditation
by the Joint Commission on the Ac-creditation
of Hospitals. In order to
achieve accreditation standards in
personnel, we estimate that the fol-lowing
additional trained personnel
will be needed:
Psychiatrists 21
Psychologists 23
Registered Nurses 365
Social Workers 99
Rehab. Workers 72
Dentists 3
In addition many more ancillary
personnel — laboratory technicians,
medical records assistants, X-ray
technicians and others—will be needed
to achieve accreditation and the
accompanying improvement in patient
care and treatment which will result.
While these positions are not cur-rently
budgeted, they will be included
in the next biennial budget request
of the Department of Mental Health.
Many more professional workers
will be needed in the future to staff
the new and expanded network of
community mental health centers. It
is estimated that a total of 80 psychi-atrists,
80 social workers, and 80
psychologists will eventually be
needed to provide treatment teams
in each of the community centers.
Many of the larger centers serving
more heavily populated areas will
need to employ several treatment
teams.
In the mental retardation centers,
urgent personnel needs are for
more doctors, psychologists, physical
therapists, occupational therapists,
nurses, recreators, teachers and cot-tage
parents.
To Train Its Own
Throughout the mental health field
the key to better patient care is more
and better trained personnel. Patient/
personnel ratios are still much too
high, although it is a tribute to pres-ent
personnel that so much has been
accomplished under limitations of
staff time.
The question which comes to mind
next is, "Where are the additional
professional personnel to be found?"
Trained mental health manpower is
in critically short supply all over the
country.
As one answer to the manpower
shortage, the Department is seeking
to "grow our own" personnel through
training programs carried on either
within the State mental health system
or in collaboration with academic
institutions. Following are some
examples of these training programs.
Fully approved 3-year residency
training programs are in operation
in two of the four psychiatric
hospitals. Currently 32 physicians are
taking their psychiatric training in
these programs. Experience shows
that many of these residents will
continue to work within the State
mental health system upon completion
of training.
ESC QUARTERLY 19
A research psychiatrist and his assistant work to close some of the gaps in knowledge about mental illness which still exist, frustrating
efforts at cure and prevention (left). In service training programs (right photo) for all mental health employees provide each with the
opportunity for furthering self-development and keeping up with new concepts and advances in the field. Hospitals and centers for
retarded have continuing education programs for aides, attendants and cottage parents.
Serving four admission areas in North Carolina and administered by the N. C. Department of Mental Health are John Umstead Hospital
in Butner (upper left); Broughton Hospital, Morganton; Cherry Hospital, Goldsboro (bottom left); and Dorothea Dix Hospital in Raleigh.
Patients admitted to the four hospitals during 1964-65 totalled over 12,500. Also there are presently 34 community mental health clinics
in the State in which patients under care in fiscal 1965 totalled over 22,000.
20 ESC QUARTERLY
John UmiteadHotpitol
)
/s y -
' —4
H r-
I
„,..,... i „
-4 -|—•
-7~r
l—i— /
1
—'i >^J>
^ K^ < .w ~~ i J
\~
HOSPITAL ADMISSION AREAS |R..i.*d July I. 1965)
I E.ilud.ng m«inll r III criminal.)
NORTH CAROLINA STATE DEPARTMENT OF MENTAL HEALTH
Psychiatric nursing affiliations
:xist in each of the psychiatric hos-jitals,
allowing undergraduate stu-lent
nurses from hospital nursing
ichools all over North Carolina to
eceive part of their training in a
)sychiatric setting. Many of these
students return after graduation to
ill positions as staff nurses in one
>f the State facilities.
For graduate nurses, a program of
)eriodic postgraduate seminars is
leld, in conjunction with the State
iniversity school of nursing.
Mental health facilities have devel-
>ped into field training resources for
)sychiatric social work students. Stu-lents
in the School of Social Work,
University of North Carolina, are
issigned field work placements in a
lumber of the Department's inpatient
Mental hospitals have had to develop a
wide range of medical services. Here a
physical therapist works with a paralysis
victim.
units and in several of the community
mental health clinics.
A number of the community mental
health centers provide training for
the mental health disciplines, includ-ing
graduate students in psychology;
psychiatric social work; and psychi-atric
residents.
In-service training programs for
all employees provide each one the
opportunity for furthering self-development
and keeping abreast of
new concepts and advances in the
field. Hospitals and centers for re-tarded
have continuing education pro-grams
for aides, attendants and
cottage parents. Appreciation of the
value of these workers as they inter-act
with patients has led to a
recognition of the need to develop
further their therapeutic potential.
Training programs for aides and cot-tage
parents are becoming more
sophisticated and comprehensive under
the stimulus of federal grant funds
being utilized for their development.
In-service training programs for
other professional staff members, in-cluding
workshops, seminars and
visiting lecture series are held
regularly in all Departmental facili-ties.
Work-Study Programs
Another potentially rewarding effort
is the work study program begun at
Dorothea Dix and John Umstead
Hospitals in collaboration with Duke
University, North Carolina College,
North Carolina State University and
St. Augustine's College. Participating
students work part-time in the hos-pitals
while pursuing their academic
programs, with the Federal govern-ment
bearing nine-tenths of the cost.
North Carolina is fortunate in
having a well-supported program of
educational loans, administered by
the Medical Care Commission, for
medical and related studies, including
mental health related fields. These
include medicine, nursing, social work,
clinical psychology and occupational
therapy. The loans are usually repaid
by exchanging one year of paid serv-ice
within the State mental health
system for each year of scholarship
support, but they may be repaid
directly with interest.
These are some of the ways in
which we are attempting to attract
and keep competent, trained person-nel
within the mental health field.
Programs of recruitment and training
will have to continue to grow and
creative new approaches to the man-power
problem must be tried if the
needs of North Carolina's mentally
ill and retarded for better care and
treatment are to be met.
Familiar to the public's concept of psy-chiatry,
a counseling interview is held.
Here a patient meets with members of the
treatment team.
ESC QUARTERLY 21
Mentally Retarded Children Need
Special People, Special Services
By Dr. J. Iverson Riddle, Superintendent
Western Carolina Center
Western Carolina Center is the
State's newest residential facility for
the care and treatment of mentally
handicapped children. Its basic ap-proach
to children encompasses the
realization that children must remain
with their parents, or as close to
them as possible, if they are to grow
to their maximum both mentally and
physically. The Center's goal is to
return as many patients as possible
to their homes and communities. For
those who because of the nature of
their handicap cannot return home,
the goal is to help them to be as
happy as possible day by day.
The Center serves the western 30
counties of North Carolina, and is
striving daily to be a part of each
area and community with which it
works. There is no wal] surrounding
it, visible or invisible. Visiting is
actively encouraged. In keeping with
this policy, there are no visiting
hours or regulations. Visitors are
asked to sign a log so that the staff
may know which children are not
being visited. In these cases, volun-teers
arrange to visit in order that
no child will feel lonely or neglected.
The staff now numbers 340 and is
composed of physicians, nurses, secre-taries,
business personnel, mainte-nance
crews, occupational therapists,
physical therapists, food handlers,
school teachers, recreators, rehabili-tation
counselors, industrial thera-pists,
psychologists, and social work-ers.
The Center also has the services
of a fulltime chaplain.
The recreators help the entire staff
to realize that play is the language
North Carolina's newest residential facility for the care and treatment of
mentally handicapped children, Western Carolina Center serves 30 western
Tarheel counties.
of childhood, and that it is often only
through play that children can be
reached. Volunteer groups as well as
individuals have helped supply toys
A project has been proposed whereby
volunteer craftsmen from the sur-rounding
furniture industries car
gather at the Center in a special
workshop to fabricate special toys foi
special children.
Trained At Center
Perhaps one of the biggest tasks
has been the recruitment of staff foi
the new facility. There is a shortage
of personnel in the field on bott
the professional and subprofessional
levels. No matter how competent those
who are recruited happen to be, they
still must be trained to work witli
mentally handicapped youngsters. The
local and area Employment Security
agencies have worked closely with
the Center's staff in both the location
and training of staff. Two hundred
and twenty-five cottage parents (at-tendants)
have been trained at the
Center in cooperation with the local
Employment Security Commission,
using the Manpower Development and
Training Act as the training vehicle.
The cottage parent trainees were
located, and in classes of 15 to 20
were trained for 400 hours. The
trainees were carefully screened be-fore,
during, and after training. Of
the 225 who were trained, approxi-mately
170 remain on the job aftei
nearly three years. The turnover rate
has, therefore, been about "0 percent.
The staff is now studying records oi
those who have left, in order to gair
a better understanding of the various
factors that influence the turnovei
rate.
Most Pressing Problem
The Center faces many problems as
it seeks new means for providing
service for western North Carolina':
mentally handicapped children. Th«
most pressing problem is the short
Buildings at Western Carolina Center are modern, well equipped and the grounds are spacious. Over 340 persons are employed at the
attractive institution, but already it is facing a serious shortage of qualified personnel. Special training is required to qualify individuals
to work with handicapped children.
ESC QUARTERLY
ige of personnel. On some shifts, one
ottage parent may be called on to
:are for 72 children. Very often the
:ottage parent works with as many
is 36 children. Additional personnel
vould make it possible to offer the
cind of treatment programs that
;hese children need and deserve. An
ncrease in personnel would be a
sound investment for the people of
tforth Carolina. It has been calculated
;hat when a child is returned to his
community from a residential facility,
;here is a savings to the taxpayer of
nore than $100,000.
Winning over the parents of the
children to new programs is always
i busy task for staff members. Be-
:ause of fears and lack of knowledge,
nany of the parents remain at a
listance. Ways must be found to
nake visiting more enjoyable for
;he parents and their child. They
nust be encouraged to actively sup-port
programs for all handicapped
children.
Probably the greatest problem faced
jy those working with mentally
landicapped children is that of "seg-nentation
of service." We are be-coming
more aware each day that
;hese children are multiply handi-capped,
and, consequently, require
services from many people of special
;raining and experience. There is a
nultitude of agencies and profession-als
becoming involved in the field,
rhere must be more effort made
toward working together, as well as
sharing information and services.
Agency boundaries must be relaxed if
a closer relationship among those
wishing to give services is to be
developed.
The Staff hopes visitors to the
Morganton area will make it a point
to visit the Western Carolina Center.
COMMENTS
(Continued from Page 2)
The articles published in this spe-cial
health-service edition of the ESC
Quarterly give us the history, growth
and needs of North Carolina's major
private and public medical institu-tions.
The shortage of trained workers in
the health service industry has caused
a sincere and growing concern among
professional people, educators, state
and federal agencies. It is evident
that training programs for health and
related professions need to be expand-ed,
and a great deal of public aware-ness,
especially among our young
people, needs to exist about the short-age
and the opportunities caused by
it. Whether enough national empha-sis
can be brought to bear, or whether
enough state and local initiative can
be generated to cope with the imbal-ance
of worker supply and demand
is yet to be seen.
Medical technologist in the Bacteriology Laboratory studying the sensitivity
of bacteria to various antibiotics.
Medical Technologists Perform
Hundreds of Laboratory Tasks
By Sarah Sands, M.T.(ASCP)
N. C. Society of Medical Technologists
Today the need for young people
in the field of medical science is at
its highest peak in the history of
medicine. Medical technology is one
of the newer para-medical fields, but
it is one of the most important and
fastest growing of the professions
which compose the medical team.
The hospital patient may know the
medical technologist only as the girl
or boy "who took my blood." But
the medical technologists play a much
greater role in the life-and-death
drama which occurs in hospitals, phy-sicians'
offices and research labora-tories.
They carefully and accurately
perform hundreds of laboratory pro-cedures
which ferret out the cause of
a pathological condition or identifies
the offender in an infectious disease.
The results of the tests performed
in the laboratory on body fluids and
tissues provide the clues to functional
changes brought about by disease.
Test results may reveal the existence
of a disease which was unsuspected
by the physician or the patient. Often
the tests are emergency procedures
such as the preparation of blood for
a transfusion, the determination of a
blood sugar level on a diabetic, or
the preparation of a quick frozen
paper thin section of tumor tissue for
examination by the pathologist who
reports his findings to the waiting
surgeon. Anytime during the day or
night the medical technologists may
be called upon to run a series of stud-ies
on an infant to determine if he
has an Rh problem which may re-quire
an exchange transfusion or to
study a spinal fluid to aid in the diag-nosis
and cause of spinal meningitis.
Fact Finding Tests
The medical technologists run a
battery of fact finding tests often
using highly complicated precision
instruments. The chemical procedures
executed may indicate liver damage,
kidney malfunction, abnormal salt
and mineral concentrations in the
body, the blood level of a drug follow-ing
therapy, the presence of alcohol
and many other anomalous conditions.
They type and cross-match blood for
transfusions and identify complicat-ing
blood antigens and antibodies in
transfusion reactions. They isolate
and identify bacteria which cause
infections and run a variety of tests
on serum that indicate infectious
processes. They cut tissue sections
transparently thin so the pathologist
may study them for abnormal cells
such as those that occur in cancer.
They count and study blood cells and
carry out many hematological studies
which aid in the detection of blood
diseases such as leukemia. They run
urinalysis and search for blood and
intestinal parasites. They perform
electrocardiograms for the detection
of abnormal cardiac impulses and
ESC QUARTERLY 23
Using a Microtome in the Histology lab,
a medical technologist cuts tissue sections.
electroencephalograms for the deter-mination
of brain wave patterns.
In recent years many medical re-search
laboratories have been estab-lished
and efforts have been concen-trated
on determining the cause, cure
and prevention of all types of patho-logical
conditions. With the publica-tion
of each new medical and scien-tific
journal, the medical technologists
find that new procedures have been
developed and improved methods for
laboratory studies have been devised.
The variety of tests are numerous
and oftentimes the procedures are
very complicated, but the results of
such tests are great aids in the early
and accurate diagnosis of disease.
The practice of modern medicine
would be impossible without depend-able
laboratory tests.
Though the profession of medical
technology had an humble beginning,
the need and demand for the labora-tory
worker has increased greatly
and the individuals presently in this
field must be highly trained and
skilled to understand and carry out
these laboratory procedures.
First School at Johns Hopkins
Before World War I most physi-cians
did the small amount of labora-tory
work required on their patients.
As medical knowledge widened, new-er
and more elaborate procedures
were developed and physicians no
longer had the time to perform ade-quate
laboratory studies; thus they
began to train assistants for this
work. Perhaps the first "school" for
training these assistants was at Johns
Hopkins University and the develop-ment
of subsequent schools of train-ing
reflected the growing recognition
of doctors throughout the country
for the need of laboratory studies in
their medical practice. At the present
time there are approximately 800
approved schools of medical tech-nology
in the United States. The
schools are located in various clin-ical
pathology laboratories of hos-pitals
and medical schools throughout
the country and many of them are
affiliated with a college or university
in a degree program.
The approved schools for the train-ing
of medical technologists are
operated under the auspices of the
American Medical Association. In
1928 The American Society of Clin-ical
Pathologists established the
Board of Registry of Medical Tech-nologists
to certify qualified person-nel
in this profession. Medical tech-nologists
and pathologists serve on
this Board which examines and cer-tifies
graduates of medical technology
schools. A Board of Schools of Medi-cal
Technology to institute the edu-cational
standards for the training of
medical technologists was also organ-ized.
The schools which meet the
standards set up by these Boards
receive the official endorsement of
the Council on Medical Education and
Hospitals of the American Medical
Association and are known as AMA-approved
schools of medical tech-nology.
In North Carolina there are 15
AMA-approved schools for the train-ing
of medical technologists. They are
located in Asheville, Chapel Hill,
Charlotte, Concord, Durham, Gastonia,
Greensboro, High Point, Raleigh,
Wilmington and Winston-Salem.
To qualify for the 12 consecutive
months of training in an AMA-ap-proved
school of medical technology
a student must have a minimum of
three years of college background
which includes the successful com-pletion
of 90 semester hours with a
minimum of 16 semester hours in
chemistry, 16 semester hours in the
biological sciences and 3 semester
hours in math. Some schools for
training medical technologists require
that their students have a college de-gree
before entering their clinical
year of training. Advanced courses
in chemistry, biology, math and phy-sics
are strongly advised. Recom-mended
electives include a broad gen-eral
education in English, the social
sciences, arts and humanities.
National Examination
After the completion of college
studies and the year of clinical train-ing
the students must pass the na-tional
examination given by the
Registry of Medical Technologists of
the American Society of Clinical
Pathologists. The Registry is the only
qualifying board for medical tech-nologists
recognized by professional
groups such as the American Medi-cal
Association, the American Soci-ety
of Clinical Pathologists, the
American College of Surgeons, the
American Hospital Association and
other authoritative medical groups.
A medical technologist collects a blood sample (left), and manipulates an advance microscope. These technicians must be highly skilled and
there are 15 AMA-approved schools to qualify medical technologists in North Carolina requiring T2 months of consecutive training.
24 ESC QUARTERLY
SANDS
Since 1961 Sarah Sands has served
is a full time Associate Professor in
he Department of Biology, Univer-sity
of North Carolina in Greensboro,
'n addition to her regular teaching
luties, she has been engaged in re-search
work concerning bacterio-jhages
of certain bacteria of medical
nterest. The research studies have
>een supported through grants from
he National Science Foundation.
A graduate of Salem College in
1945, Miss Sands completed training
n the School of Medical Technology,
Bowman Gray School of Medicine,
rVinston-Salem, and obtained a Mas-er's
degree in Bacteriology at the
Medical Units, University of Ten-lessee,
Memphis, Tenn.
She instructed in the Department of
3athology and Bacteriology at the
University of Tennessee Medical
School, 1950-1953, and subsequently
spent six months with a research
earn in Japan. Miss Sands returned
:o North Carolina in 1958 to teach at
he University of North Carolina in
jrreensboro and has been associated
vith the Department of Pathology,
Moses Cone Memorial Hospital.
The successful completion of train-ing
and attaining competent Regis-try
examination scores indicate that
the students are qualified profession-ally
as laboratory technologists and
are identified as Registered Medical
Technologists who are entitled to use
the letters MT(ASCP) after their
name.
Newer Specialties
There are several areas of certifi-cation
for specialties related to med-ical
technology. Different examina-tions
and different educational back-grounds
are required for the various
specialties. In bacteriology and chem-istry,
board certification is available
to college graduates who have ma-jored
in bacteriology or chemistry and
have had at least one year of expe-rience
in that field or who have ob-tained
a Master's Degree in one of
these sciences. Blood banking is an-other
area of specialization and this
requires an additional year of train-ing
after certification as an MT
(ASCP). Among the newer special-ties
are cytotechnology, the study of
exfoliative cells of the body in the
detection of abnormal cells which
may indicate the presence of cancer,
and nuclear medical technology which
involves the use of radioisotopes in
the study of vital functions.
Among the many well recognized
scientific journals available are two
which specifically provide information
to the medical technologists. The
Registry of Medical Technologists of
the American Society of Clinical Pa-thologists
publishes and distributes
the Technical Bulletin of the Regis-try
of Medical Technologists to all
registrants. The American Journal
of Medical Technology is published by
the American Society of Medical
Technologists, an organization which
was established in 1933 by registered
medical technologists.
Annually the American Society of
Medical Technologists convenes for
a week of workshops and refresher
courses. They hear scientific lectures
by outstanding investigators in the
various phases of laboratory medicine
and participate in scientific discus-sions
as well as present papers on
original work. These educational pro-grams
are also promoted through
state, district and local medical tech-nology
organizations to help the
medical technologists keep abreast of
the many advances in the ever pro-gressing
field of clinical medicine.
The North Carolina Society of Med-ical
Technologists holds a fall sem-inar
and spring convention each year.
These professional organizations
are devised to promote the profes-sion
of medical technology, to main-tain
the high standards and ideals of
this profession, to serve as a con-tinuing
means of education for lab-oratory
personnel and to aid in re-cruiting
and encouraging young
people to enter this profession.
Scholarships are available through
state and national organizations and
from federal funds to assist these
students with expenses during their
training.
Shortage of MT Personnel
There are over 37,000 ASCP Reg-istered
Medical Technologists in the
U. S. today. Approximately 10,000
of these are members of the Ameri-can
Society of Medical Technology
and the total membership in the
North Carolina Society of Medical
Technologists exceeds 200 this year.
Though membership in these organi-zations
has grown tremendously in
recent years, there are far from
enough Registered Medical Technolo-gists
to meet the need and demand
in the laboratory facilities in the
U. S. A recent survey of medical per-sonnel
in North Carolina revealed
(See MED TECH, page 33)
The scientific skills of bacteriology study (left) and the technical methods of chemistry (right) come under the adroit hands of the
trained technologist. Certification for registered medical technologists is available in newer specialties such as chemistry and bacteriology.
To certify, a technologist must hold a master's degree in one of the fields or hold a bachelor's degree with one year experience.
ESC QUARTERLY 25
FEDERAL-STATE FUNDS CONSTRUCTED
240 HOSPITAL PROJECTS SINCE 1947
created as an agency to serve hospi-tals
and related medical facilities in
somewhat the same way as the Board
of Education is related to public
schools and the Highway Commission
to the State's road system. The Com-mission
is broadly responsible for
three main programs: (1) The con-struction
of medical facilities using
By William F. Henderson
Executive Secretary, N. C. Medical Care Commission
With stimulus from federal funds
available under the Hill-Burton Act
inaugurated in the mid-40's and with
special State appropriations, hospitals
and related facilities have expanded
in the two decades beyond any com-parable
period in the State's history.
Under this program, the Medical
Care Commission has inaugurated 422
medical facility projects costing ap-proximately
$300 million. In a number
of projects, North Carolina has con-structed
more hospital and health
facilities under the Federal program
than any other state. Since 1947,
approximately 240 hospital projects
have been constructed involving al-most
13,000 beds.
In 1947, when the construction pro-gram
actually got underway, North
Carolina had some 9,000 general hos-pital
beds. There are now either
existing or under construction 18,500
general beds, an increase of over 100
percent. Including beds in special
hospitals, federal, tuberculosis and
mental facilities, the State upon the
completion of units under construction
will have a total of 33,000 beds. In
addition, the Commission has con-structed
88 public health centers
throughout the State. There are
presently under development contracts
totalling $80 million.
With the advent of Blue Cross and
other hospital insurance programs
and with the increasing availability
of modern medical facilities, utiliza-tion
has continued to rise. For ex-ample,
in 1947 the average percentage
of occupancy of North Carolina hos-pitals
was about 72 percent of capac-ity.
Occupancy is now running over
75 percent in spite of all of the
building that has been accomplished
during the 20-year period. This dra-matic
expansion of facilities obviously
has demanded more people to staff
our growing health services. The
Duke Endowment reported that in
1947 its assisted hospitals in the State
had approximately 8,000 full-time
employees. During that year, these
hospitals provided 2,245,000 adult
days of care requiring 1.3 employees
per inpatient per day. The En-dowment
reports that in 1964 the
hospitals assisted during that year
provided 4,334,000 adult days of care
and employed 26,000 people full time,
or 2.2 employees per inpatient per
day. Thus, during the two decades,
employment has more than tripled.
However, the alarming increase in
unfilled positions, sometimes neces-sitating
the closing of beds, has
accelerated emphasis upon the recruit-ment
and training of literally thou-sands
of more people than are pres-ently
available to staff existing
programs—to say nothing of the
facilities under construction and in
planning.
Student Scholarships
Conscious of the acute shortage of
personnel, the Commission has ex-panded
its program for assisting
students in the medical and related
professions. For years, the Commis-sion,
using State appropriations, has
provided loans to needy students of
medicine, dentistry, pharmacy, nurs-ing
and related fields of study who in
accepting the loans agree to practice
in rural areas, mental hospitals and
other specified health programs within
the State where there are critical
shortages. Because of the growing
acuteness of the problem of obtaining
sufficient personnel, the Commission
recently modified the program to for-give
the loans to those recipients who
practice in North Carolina on the
basis of the cancellation of an aca-demic
year's loan for each calendar
year of service. Other professional
areas of study have been added to
include public health, physical and
occupational therapy, social work,
psychology, dental hygiene, dietetics,
medical record library science, medical
technology, nurse anesthesia, medical
recreation and optometry. As a result
of this modification, applications for
educational assistance under the pro-gram
increased almost 200 percent
during the past year.
Three Main Programs
The Medical Care Commission was
Executive Secretary of the North
Carolina Medical Care Commission
is William F. Henderson, a 1935
graduate of the University of North
Carolina. He attended the UNC
graduate school in 1937 and 1938.
Up to 1939, Henderson was a
public welfare worker in North Caro-lina
and then joined the Children's
Home Society at Greensboro as
Associate Superintendent. Following
World War II, he held several
hospital administrative positions, in-cluding
the Onslow County Hospital
at Jacksonville and the Moore County
Hospital at Pinehurst. In 1952,
he joined the staff of the Medical
Care Commission as Hospital Ad-ministrative
Consultant and became
Executive Secretary of the Com-mission
in 1958.
He is a member of the N. C. Hos-pital
Association, a member of the
Board of Directors of the American
Association for Hospital Planning and
is Secretary of the Association of
State and Territorial Hospital and
Medical Facilities Survey and Con-struction
Authorities.
26 ESC QUARTERLY
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The Forsyth '
Salem, complet
the Hill-Burton
General Hospital, Wlnston-ed
in 1963 with funds from
Act.
Federal and State grants-in-aid in-volving
hospitals, diagnostic and
treatment centers, long-term care
facilities, public health centers, re-habilitation
facilities, mental health
centers and facilities for the mentally
retarded. In this connection, it assists
hospital planning councils with
federal grants, conducts research
projects to benefit the over-all per-formance
of hospital construction
and maintenance. (2) The licensing
of hospitals. State law requires that
hospitals meet certain codes of con-struction
and operation and periodic
surveys of some 170 hospitals in the
State are made to determine compli-ance
with recognized standards. (3)
Student scholarship fund. This section
provides educational assistance to
students in the medical and para-medical
areas in return for service
to the State. Through its scholar-ships,
the Commission assists rural
communities, mental and other public
health and hospital programs in
attracting physicians and other health
specialists to practice in areas of
acute shortages and cooperates with
educational institutions in providing
grants for students in the health
professions.
Grace Hartley Memorial Hospital, Banner Elk
Wake County Health Center, Raleigh
1 i
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. I «W Kpw
ifi p «
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I* I 1
M. 1 !
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Wilson Memorial Hospital, Wilson
Albemarle Hospital, Elizabeth City
CHARLOTTE COMPANY
HAS LONG SERVICE TO
DENTAL PROFESSION
The dental profession has been
using cotton pellets, cotton balls, and
dispensers made by Richmond Dental
Cotton Company since 1895, the busi-ness
having been originated in Niag-ara
Falls, New York, by Dr. Albert
Richmond.
The firm later was managed by
Miss Muriel Berkinshaw and the in-terests
maintained in Niagara Falls
until 1947. Carolina Absorbent Cot-ton
Company of Charlotte, N. C.
(subsidiary of Barnhardt Manufac-turing
Company selling to the medi-cal,
hospital, and industrial fields),
supplied the cotton for many years.
It was only natural, when Miss
Berkinshaw and her associates de-cided
to retire in 1947, that the com-pany
be offered to the Barnhardt
interests.
The time lapse in moving the per-sonnel
and machinery from Niagara
Falls to Charlotte was only two
weeks. The original firm name had
been retained and cotton pellets cot-ton
dispensers were, in 1947, still the
only Richmond Dental items.
The dental business was new to
the Bernhardts, and for a while their
only contact with the profession was
at dental meetings. After working
extensively with dental dealers, it
wasn't long until they discovered that
the demand for Richmond items was
even greater than anticipated.
In 1952, cotton rolls were added to
the Richmond line. The very absorb-ent
rolls are all-cotton, held by braid-ed
threads, having no starchy coating.
Constant advertising to the dental
profession and trade and at dental
convention exhibits created a large
demand for this new item within a
short time.
In August, 1953, the company was
incorporated in the State of North
Carolina.
The manufacturer has since added
to the line: exodontia sponges (plain
gauze and cotton-filled gauze) , cot-ton-
tipped applicators, and tissue
wipes.
The coveted Army-Navy "E" was
awarded to the entire Barnhardt or-ganization
early in 1943 for its splen-did
war-time record.
ESC QUARTERLY 27
GASTON MEMORIAL NEEDS MORE SPACE, PERSONNEL
By Gladys Stenstrom
Cold facts, bed and space shortages,
lists of statistical information, a tight
labor market, and personnel problems
sometimes seem a little out of place
in the mind's-eye picture of a com-munity
hospital. For this is where
we go when we are sick, and although
"tender, loving care" has become a
worn cliche, what we want when we
are sick is exactly that, supported by
good quality service, and all the pro-fessional
skill we can get.
The primary function of a hospital
is, of course, to offer the best possible
patient care to the sick and injured
who enter its doors, and Americans
have come to expect this. To provide
this type of hospital care, television
dramas to the contrary, many un-dramatic
aspects work together in
the behind the scenes activities. The
variations involved in the hospital can
be seen in the personnel office where
there may be openings at one time
for a printer, janitor, anatomy in-structor,
pot washer, medical librar-ian,
or a laundry manager. The need
for nurses is ever present.
Reflects the Community
A hospital is in one sense a mirror;
it reflects the community it is serving.
The changes that occur in the local
population, industry, or education will
eventually reveal themselves in the
hospital, both in its staff and in the
patients committed to their care.
To apply this thought to a specific
situation, we might consider Gaston
Memorial Hospital, a 228-bed, 31-
bassinet, short-term, general, com-munity
hospital, operated by a board
of trustees composed of 12, who serve
without pay and represent the various
towns in Gaston County. The day-to-day
operation of the hospital is dele-gated
by the trustees to an experi-enced
hospital director, James A.
Brown, Jr. Qualified department heads
in turn supervise their specific areas
of service.
The hospital is fully accredited by
the Joint Commission on Accreditation
of Hospitals and licenced by the
North Carolina Medical Care Com-mission.
Among the patient services offered
at GMH are fully equipped clinical
laboratories directed by a pathologist,
a pharmacy, physical therapy depart-ment,
intensive care unit, operating
and obstetrical suites, and dental
facilities. Both diagnostic and ther-apeutic
X-ray services are supervised
by a team of three radiologists.
The medical staff is made up of
dedicated and skilled physicians and
surgeons, representing all of the
major specialties with board certified
men. A dental staff is also a part of
the medical staff.
A full-time chaplain, who is an
ordained minister with additional
training in the hospital chaplaincy,
counsels and ministers to patients,
bereaved families, student nurses, and
employees. He works closely with the
doctors and local ministers.
Auxiliary Hospital
We are proud of our hospital aux-iliary,
organized in 1952, that has
served us faithfully in countless ways.
Its present membership numbers 250.
A very active junior auxiliary "Candy-stripers"
step into volunteer service
positions throughout the hospital as
soon as summer arrives. The program
is headed by a director of volunteers
who is a member of the hospital staff.
Gaston Memorial maintains and
operates its own modern laundry. This
building also houses the housekeeping,
engineering, and sewing departments.
The laundry, turning out 100,000
pounds of wash every month, has
experimented successfully with the
employment of women in the upper
age brackets only. Most of these
women are in the social security
bracket and have proven very depend-able.
They seem to enjoy their light,
part time duties arranged on an
alternating shift basis between two
groups.
During this past year, Gaston
Memorial Hospital recorded 10,499
adult and pediatric admissions, with
67,641 days of care rendered.
Emergency departments in many
of the nation's 7,000 hospitals have
been under increasing pressure, in
recent years, resulting from the
changing role of the department from
a true emergency room to an out-patient
clinic. This has been our
experience as well, with 21,934 emer-gency
room visits in one year. This
is a climb from 16,177 in 1960. To ease
the situation in our emergency suite,
changes have just been completed,
adding space for more patients and a
more comfortable outpatient waiting
area. Traffic patterns have been re-designed,
gaining a separate entrance
for stretchers with more direct access
to the emergency room.
Three Per Patient
It is generally accepted that to give
proper care a hospital needs two and
one-half to three employees per every
A freshman class at the Gaston Memorial Hospital School of Nursing receives instruction from registered nurses Mrs. Larry Kennedy and
Miss Louise Taylor (left). Mrs. Wade Carter, recovery room nurse (right) administers to patients with complete and up-to-date facilities.
28 ESC QUARTERLY
patient. Since a hospital is by neces-sity
open 24 hours, seven days a
week, there are many jobs that must
be covered around the clock. Filling
these occupations requires four and
one-half persons each, to allow for
vacations, days off, etc. In a tight
labor market these facts can offer a
challenge to department heads and the
personnel officer.
In pointing up the effect of the
community on the hospital, there are
several factors that can be brought
out. The population growth of Gaston
County has been on an upward swing
for a number of years. During the
ten year period from 1950 to 1960,
the city of Gastonia experienced an
increase of 61.4 percent, and the
county increased by 15 percent. In
this same ten year period, Gaston
Memorial Hospital grew from 65 beds
to 198 beds.
Along with the population increase,
industrial growth took place at such
a pace that it raised Gaston County to
second in the state with industries
employing more than 100 persons.
As these diversified industries have
located in the county, attracting much
of the available personnel, unemploy-ment
has hit a record low. This has
brought about increases in real in-come,
with the majority of today's
employees receiving generous fringe
benefits, including hospitalization, and
as income has increased, the demand
for hospital and health services has
increased accordingly. Additional pro-grams
sponsored by the government,
such as Medicare and the anti-poverty
programs will create the need for
medical and hospital services beyond
the normally expected increases.
Bond Issue Rejected
These community development
trends are important in the long-range
planning of bed needs by hospital
authorities. It is not secret that at
the present time, Gaston Memorial
Hospital with 228 beds is far short
of being adequate to meet the needs
of a county that shows a population
of 135,836 in a recently completed
census. Furthermore, only 140 of the
total bed count can be considered
"acceptable" beds by hospital stand-ards.
The current bed count was
reached by putting two beds in rooms
designed for one, and by placing beds
in corridors and alcoves. This has
been necessary in order to keep pace
with the demands placed on the hos-pital
facilities by a growing com-munity,
and in view of this need, the
board of trustees recently approached
the citizens with a plan to build a
400-bed hospital on a new site. The
building program was dependent on a
bond issue, which was rejected by the
voters of the community. Disappoint-ment
in the hoped for relief from
crowded conditions has had some
effect on our staffing situation.
In reviewing the existing staff
vacancies, it appears that the openings
are mainly on two levels: the profes-sional,
and the unskilled. Despite the
terminology, this latter group is im-portant
to the efficient performance
of food and housekeeping services, to
name a few.
It is easy to understand why a
hospital might be short of non-skilled
personnel with a tight labor market
and industrial wage scales that can-not
be met by a non-profit organiza-tion.
But what about the professional
people whose training is geared solely
to giving hospital care ? Where are
they?
In the first place, the nursing situ-ation
in North Carolina has been
described by experts as being acute.
Results of a survey made by the
Duke Endowment in 1962, showed a
total of 2,106 unfilled full-time posi-tions
for professional nurses in this
state. In addition to the actual short-
.- 1
Administrators of the Gastonia Memorial Hospital include Miss Margaret Cudd, R.N.,
director of nursing; James A. Brown, Jr., hospital director; Jefferson C. McDuffie, person-nel
director; and Bill McSwain, comptroller.
age of nurses, prosperity has made
its mark. With increased family in-come,
the nurse does not have to leave
her family and work the necessary
tours of duty in the hospital. Too,
it has become increasingly difficult
to obtain reliable household help, so
that a young mother can be free to
work. This very situation is one affect-ing
our medical records department
at the present time. It seems that an
important service could be performed
by the anti-poverty program in edu-cating
people who need work but
still reject so-called unskilled jobs as
subservient and therefore undesirable.
Moreover, this program could work
out a training in hospital services that
would relieve the hard core of profes-sional
help that remains available.
Seeks Relief
Gaston Memorial Hospital itself
makes a contribution toward relief
of the nursing shortage through its
work in nursing education in its two
schools: the three-year diploma school
for professional nurses, and the one-year
practical nursing school.
The professional school enrolled its
first class on January 15, 1947, just
one year after the hospital was
organized. The school holds as its
central objective the preparation of
selected individuals to practice pro-fessional
nursing in first level posi-tions
in general hospitals. In its
desire to offer a high level of nursing
education, the school is affiliated with
Gaston College, and the students
receive college credit for courses
taken there.
During their senior year, profes-sional
students attend classes at
Dorothea Dix Hospital in Raleigh, for
their psychiatric nursing education.
Students are also exposed to com-munity
resource agencies such as
will aid in the study of both the
normal and the handicapped child.
The school of nursing has facilities
to accommodate 100 students and oc-cupies
a modern, attractive, and well-equipped
building. The students enjoy
their own tennis and basketball courts
and take advantage of both the study
and recreational advantages offered
them.
The school curriculum is reviewed
frequently and upgraded under the
direction of Miss Margaret Cudd,
R. N., director of nursing, and Miss
Louise Taylor, R. N., associate direc-tor
of nursing education.
Gaston Memorial Hospital also
maintains a school of practical nurs-ing,
which graduated its second class
in March of this year. Students
completing this course of study are
then eligible to take their state board
examinations for licensing of practical
nurses. The school presents a balanced
(See GASTON, page 33)
ESC QUARTERLY 29
NCSNA Blames Nurse Shortage On
Low Salaries, Inadequate Training Plan
By Marie B. Noell
Executive Secretary, N. C. State Nurses Association
Today there are more and better
prepared nurses in North Carolina
than ever before.
Yet in nearly every community of
the State there is considerable public
attention and concern about the
shortage of nurses. Many experts feel
that with the impact of the Medicare
program, the shortage of nurses will
become even more severe.
The most recent state-wide survey
of nurse needs among users of pro-fessional
nurses indicates that there
are more than 2,000 unfilled full-time
positions. There are more than 15,000
registered nurses in North Carolina,
and about 12,300 of them are prac-ticing.
Some 2,500 are listed as "in-active."
The largest group of nurses,
of course, is practicing in hospitals
or other institutions—some 8,100.
About 475 are teaching in schools of
professional nursing and in practical
nurse programs. Another 1,350 are
in private duty practice, while nearly
700 are in public health. There are
about 225 occupational health nurses
in North Carolina, and more than
1,175 engaged in nursing in doctors'
offices. The remainder are in school
nursing and other specified fields. The
shortage is being felt in all areas of
practice, and it is a national one.
In a Report of Survey of Nursing
Education in North Carolina publish-
New methods of health services are
demonstrated to a group of nurses at-tending
a clinical meeting.
ed in July, 1964, author Ray E.
Brown states that North Carolina is
"doomed to a chronic and severe nurs-ing
shortage for the next decade."
The number of graduates produced
annually by the State's schools of
nursing is not nearly enough to fill
the gap.
There are several reasons why
there are not enough nurses to ful-fill
North Carolina's nursing needs.
First, Hill-Burton funds have en-abled
communities in this State to
build and expand hospitals and other
health care facilities rapidly, but
there was no accompanying plan to
provide the skilled personnel to staff
these facilities. Second, the low
salaries and unfavorable working con-ditions
of nursing positions have
caused many promising young people
to turn to other more lucrative and
more attractive careers. In recent
years many new career opportunities
have opened up to young people,
especially to women, who might other-wise
have gone into nursing.
A third reason is the poor quality
of nursing education programs, re-sulting
in a high percentage of fail-ures
in the licensure examination.
Foster High Standards
The North Carolina State Nurses'
Association, membership organization
for registered nurses, has served as
the spokesman through which nurses
have sought for many years to call
these facts to the attention of the
public. The functions of NCSNA are
to foster high standards of nursing
practice, to promote the professional
and educational advancement of
nurses, and to promote the welfare of
nurses—all to the end that all people
may have better nursing care.
NCSNA is a constituent unit of the
American Nurses' Association.
With the establishment of the
North Carolina Medical Care Com-mission
to serve as the official state
agency to administer Hill-Burton
funds, the NCSNA began to seek
ways to increase the supply of pre-pared
nurses to staff the new hospi-tals
and clinics springing up all over
the State. Efforts to obtain state
funds for scholarships for nurses
were not successful until recent years.
Now a loan-scholarship program for
the health professions is administered
through the Medical Care Commis-sion
and is used heavily by nurses
both in basic programs and in gradu-ate
work.
The American Nurses' Association
was successful in 1964 in obtaining
passage of the Nurse Training Act,
under which low-interest loans are
available to nurses; traineeships are
continued for nurses in teaching, ad-ministration
and supervision, and
public health; and construction
grants and project grants are avail-able
to schools of nursing.
Improving the economic situation
of nurses presents a more formidable
problem. This problem has always
plagued the nursing profession. To-day
a beginning nurse, with her post-high
school preparation, receives a
beginning salary less than the na-tional
average for factory workers.
Her working schedule involves eve-ning
and night shifts and weekends.
Fringe benefits are poor. Most nurses
work in non-profit hospitals which are
exempt from the protective labor
legislation other workers enjoy.
To improve the working conditions
of nurses so that the profession can
compete as a career, NCSNA conducts
a continuous program of promoting
salary improvements, better fringe
benefits, more

3/3-"/
INorm Larouna iiaie L.u.vjry
Raleigh
MEDICAL PROFESSIONS EDITION
Volume 23, No. 3-4
l"HE
QUARTERLY
*s
.
^0^
v
Kendall
problems created by
CHAIRMAN'S
COMMENTS
Henry E. Kendall
Chairman
N. C. Employment
Security Com/mission
?*1 "The rapid advances in medical
science and technology added to the
aroused public interest in attaining
and maintaining high quality of
health services have compounded the
health manpower shortages." This
statement was made by Dr. Edwin L. Crosby, President of
the National Health Council. Dr. Crosby continued: "The
national interest and concern today have placed more
emphasis on the needs for more health workers to provide
the optimum of services and facilities to maintain a high
level of health for our citizens."
The nation faces a shortage of qualified and skilled medical
service workers at a time when increasing population taxes
existing hospital and other medical facilities. In North Caro-lina,
our hospitals are short handed. Our public and private
medical research staffs need additional people, and medical
institutions are crowded with patients. The doctor-patient
ratio in North Carolina is one to 11,000.
"And the critical situation we face now in North Carolina
and in the nation will get worse before it gets better,"
reports the State Department of Health.
"Today the need for young people in the field of medical
science is at its highest peak in the history of medicine,"
reports the North Carolina Society of Medical Technologists.
"Today there are more and better prepared nurses in North
Carolina than ever before. Yet, in nearly every community
in the State," according to the N. C. State Nurses Associa-tion,
"there is considerable public attention and concern about
the shortage of nurses."
Commenting on the medical demands exerted by the new
Medicare Law, the Health Planning Council for Central
North Carolina predicted that "we will continue to pay the
price of shortages of personnel and facilities, expensive
instances of duplicated effort, and inefficient utilization of
skilled health workers. This unhappy condition will persist
until we awaken to the necessity for far better planning in
this field than has generally been the case heretofore."
This is the first issue of the ESC QUARTERLY ever
devoted to shortage occupations, in this case health service
and medically related professions. Our solicitation for articles
disclosed serious personnel shortages in a number of North
Carolina medical institutions. These shortages, which have
gradually increased during the past decade, came basically,
because the number of persons entering health service
occupations has not kept pace with the growing demands for
medical treatment from an increasing population.
One organization in North Carolina, "Health Careers,"
was established solely to recruit and influence young persons
toward health service jobs, and all of our medical insti-tutions
and professional associations, in some degree are
assuming the task of personnel training to fill job vacancies.
Most industries in our State require additional skilled
workers, and our health service industry, if it can be called
that, is in no less straits for the qualities of skilled and
trained technicians—whether it be the clinical competence of
a laboratory director, the efficiency of a registered nurse, the
dexterous sense of the physician or the professionalism of
the hospital administrator.
(Continued on page 23)
2 ESC QUARTERLY
THE
ESC QUARTERLY
MEDICAL SERVICE INDUSTRY
Volume 23, No. 3, 4, 1965
Issued at Raleigh, N. C, by the
EMPLOYMENT SECURITY COMMISSION
OF NORTH CAROLINA
Commissioners
Billy Earl Andrews, Durham; Charles L. Hun]
Monroe; James W. Seabrook, Payetteville ; Henry
Kendall, Raleigh; Harold F. Coffey, Lenoir; R. Di
Hall, Belmont; Samuel F. Teague, Raleigh.
State Advisory Council
Public representatives: James A. Bridger, Blad
boro, Chairman: Sherwood Roberson, Robersonvil
Mrs. W. Arthur Tripp, Greenville; Employer rep
seniatives: A. L. Tait, Lincolnton and G. Maur
Hill, Drexel. Employee representatives: Mer
Ward, Spencer, AFL, and H. D. Lisk, Charlotte, 1
HENRY E. KENDALL Chairn
R. FULLER MARTIN Dirl
Unemployment Insurance Division
JOSEPH W. BEACH DireJ
State Employment Service Division
H. E. (Ted) DAVIS , Ed
Public Information Officer
|
Sent free upon request to responsible individual
agencies, organizations and libraries
Address: E.S.C. Information Service,
P. O. Box 589, Raleigh, N. C.
COVER LEGEND
What better illustration to
medical services than the sm
faced youngster and the public r
nurse? Perhaps no other prof
instills such dedication as the
herent in our medical servants
we wonder just how many va
tions have been given by the
lady and how many bright eyes
watched her shining needles. Despite his age, the si
bewildered young man is, perhaps, not unlike us c
Our knowledge of medicine and medical practice
methods is often bewildering, and we are wholly ine
prognosis and treatment without the physicians and
protessionals. The young lady in the picture we b
illustrates the opportunities which exist among the m
services, because from every contributor to this iss
the Quarterly we learn of a growing shortage of f
>ei
sional medical workers.
MEDICAL SERVICE WORKERS TRAINED UNDER FEDERAL STATE PROGRAMS
By Dave Garrison
Bureau of Employment Security Research
Almost 1,700 workers have been
ained for North Carolina's hospi-ils
and medical-eare institutions un-jr
the Manpower Development and
raining Act since its passage in
)62. Designed to reduce unemploy-ed,
the MDTA has enabled many
arsons to qualify for jobs which they
ight not have otherwise obtained,
t the same time, the program has
rovided a trained labor supply in
any hospital and related occupa-ons,
which traditionally have be^n
ifficult to fill.
Under institutional-type training
rograms, which are administered by
le Department of Community Col-ges
of the State Board of Educa-on,
there have been 509 persons
irolled in 13 different MDTA train-lg
projects, located in the Durham,
reensboro, Kinston, Morganton, New
ern, Rocky Mount, Spruce Pine and
/ilson areas. Although some of these
rograms are not yet completed,
mailable reports on the post-training
nployment experience of the trainees
idicate that 235 trainees have se-ared
employment directly related to
ieir training. The institutional pro-rams
developed thus far have been
mited to four occupational fields:
urse aide, ward attendant, psychia-
'ic attendant, and dental hygienist.
Perhaps because training of work-rs
in medical occupations lends it-jlf
more readily to on-the-job type
ituations where facilities, equipment
nd instructors are usually already
vailable, the MDTA on-the-job train-ig
programs, administered through
ie U. S. Bureau of Apprenticeship
nd Training, have been more wide-pread
than the institutional type
rograms. To date nearly 1,200 per-ms
have been enrolled in on-the-job
raining programs in hospitals lo-ated
in Concord, Chapel Hill, Greens-oro,
Mount Airy, North Wilkesboro,
parta, Jefferson, Wilson and Win-ton-
Salem. Of 980 persons who have
lready completed OJT training, 753
ave remained in training related
ibs.
A much greater variety of training
as been offered under the OJT pro-ram,
ranging from lower skilled
)bs, such as orderly and maids, to
ie more complex occupations of
iboratory technician and staff nurse
upgrading).
MDTA TRAINING IN HOSPITAL OCCUPATIONS
INSTITUTIONAL PROJECTS
Current
Area Occupation Approved Enrolled Completed Enrollment
Durham Ward Attendant 40 31 27
Greensboro Nurse Aide 30 35 30
Greensboro Nurse Aide :;o 29 13 15
Greensboro Dental Hygienist 60 20 20
Kinston Nurse Aide 30 23 20
Morganton Ward Attendant 180 156 156
Morganton Psychiatric Attendant 50 36 34
Morganton Ward Attendant 48 29 27
New Bern Nurse Aide 15 16
Rocky Mount Nurse Aide L5 15 15 I)
Spruce Pine Nurse Aide 11 15 14
Wilson Nurse Aide 45 45 11 I)
Wilson Nurse Aide y professional schools in order to
illow students to receive first-hand
nformation and impressions of the
ollege facilities and courses offered,
hospitals are encouraged to have
ipen houses giving a view of the
iractical applications of a career in
. hospital.
Career-oriented work experience
nth a health practitioner, such as
)andy Striper programs in hospitals,
re beneficial to young persons inter-sted
in a health career.
Health Careers for North Carolina
s a growing, vital program, changing
o meet the need of North Carolina
tudents. Staff members continuously
eek any improvements which they
an make in the program. The coor-inators
attend periodic workshops
yhich are planned by the director,
'hese workshops provide them with
he opportunity to exchange ideas
nd re-evaluate programming tech-iques.
As long as the crucial short-ge
of health personnel exists in the
tate, Health Careers will strive to
eep abreast of the ever-expanding
ealth field and be aware of the im-ortance
of tailoring the program to
t the needs of the time.
The
ke Endowment
The philanthropy of the Duke En-dowment
extends to four areas of
service—health, education, child care,
and religion.
In planning the Endowment, which
was established on December 11, 1924,
James B. Duke selected hospitals in
his native North Carolina and in
South Carolina as major beneficiaries
because he considered them indispen-sable
institutions for "increasing the
efficiency of mankind and prolonging
human life." He described their facili-ties
as "essential for obtaining the
best results in the practice of medi-cine
and surgery" and expressed the
hope "that the people will see to it
that adequate and convenient hospi-tals
are assured in their respective
communities, with special reference
to those who are unable to defray
such expenses of their own."
Mr. Duke died on October 10, 1925,
before the Endowment was a year
old. In his will he left, among other
bequests, $4 million for building and
equipping a medical school, a hospital,
and a school of nursing at Duke
University. The provision for these
schools was an indication of Mr.
Duke's understanding of health care
needs at that time and of his fore-sight,
for the shortage of persons
trained to serve the sick has developed
into an extremely critical problem.
$234.5 Million
In the Endowment Indenture, Mr.
Duke set forth terms under which
available funds were to be distri-buted.
Those given for health help
hospitals finance charity services,
assist in the building, equipping, and
purchase of hospitals, and make pos-sible
improved health care through
special projects designed for this
purpose. These allocations and appro-priations,
which had amounted to
more than $53.5 million at the end
of 1965, the forty-first year of the
Endowment, have had a tremendous
impact on the adequacy and quality
of health care in the Carolinas and
also on the economic progress of the
area. Add to these the sums provided
for the four beneficiary educational
institutions, child care institutions,
and religious causes, the total is more
than $234.5 million. This averages
nearly $5,720,000 a year channeled
into four areas of service to mankind.
While the financial contribution of
the Endowment is important in it-self,
it is in what the Endowment
has encouraged and helped the people
of the Carolinas to do for themselves
that its greatest value lies. This can
be illustrated by remembering a 1924
study of N. C. hospitals made by
Dr. W. S. Rankin, director of the
Hospital and Orphan sections of the
Endowment for 25 years and now
Trustee Emeritus and a consultant to
these sections, which revealed that
44 of North Carolina's 100 counties
had no short-term general or special
hospital beds and that in the whole
State there were only 1.5 beds for
each 1,000 persons. By 1964 all ex-cept
16 of North Carolina's counties
had such facilities and there were
3.4 beds for each 1,000 of the popu-lation,
which compares favorably
with the national figure of 3.6 beds.
Determining Factor
Through these years of progress,
funds of the Duke Endowment to
help finance hospital facilities have
had a part in making it possible for
thousands to have medical care which
they otherwise might have been de-nied.
This is true because hospital
beds convenient to most of the popu-lation
have been provided and be-cause
the presence of a growing
number of hospitals, the improved
facilities, and the availability of
nurses and technicians have caused
many physicians to settle in com-
ESC QUARTERLY
Bachracli Bachracl
JAMES R. FELTS, JR.
Hospital and Child Care Section
paratively small communities when
they would not have considered doing
so without these advantages.
With the help of Duke Endowment
contributions, complete hospitals have
been built where there were none,
additional beds and equipment have
been made possible at existing insti-tutions,
and services have been ex-panded
and improved. In some cases,
privately owned hospitals have been
purchased and replaced by modern,
nonprofit community institutions. At
times, funds of the Endowment have
made up the difference between the
money on hand from other sources
and the cost of the proposed projects,
thus becoming the determining fac-tor
in providing complete new hospi-tals
or more adequate facilities and
services in institutions already in
operation.
Concern of the Trustees of the
Endowment for charity care and ade-quate
facilities is accompanied by
active interest in helping to increase
the number of physicians, nurses,
and technicians, to improve the ef-fectiveness
of graduate medical edu-cation,
to increase outpatient services,
to attract more doctors to general
practice, to provide facilities for the
care of the age and the chronically
ill long-term patients, and to bring
improvement wherever it is needed
in the care of the sick.
In North Carolina where a study
conducted by the Endowment in 1962
showed an alarming shortage in
medical and paramedical personnel,
the foundation helps to support a
statewide program, Health Careers
for North Carolina, which was initi-ated
by the North Carolina Hospital
Association to attract qualified young
people to health careers. The pro-gram
began in 1963 and an almost
immediate result was that in 1964
applications to health related schools
were 36 per cent greater than in
1963 and admissions to these schools
were 20 per cent greater. The pro-gram,
which is administered by the
Education and Research Foundation
of the North Carolina Hospital Asso-ciation,
is in its fourth year. When
it was begun, the estimated need of
nurses, technicians, and others for
health service positions was 4,817. In
spite of the excellent accomplish-ments,
the need continues to be very
large, for the growth in population,
the increase in services available for
the care of the sick, the broader par-ticipation
in hospitalization insurance
plans, and the coming of Medicare
have brought new and greater de-mands
for people to serve the mount-ing
number of patients. At a time
when hospitals are operating at capa-city
and more beds are needed des-perately,
there are facilities in the
State which cannot be used because
the hospitals are unable to obtain the
staff necessary to operate them.
In another program to create in-terest
in health careers, the Endow-ment
joined the State Board of
Education in paying the cost of a
study of nursing education in North
Carolina which was sponsored by the
North Carolina Board of Higher Ed-pr?
IK.
MARSHALL I. PICKENS
Vice Chairman, The Duke Endowment
ucation, the State Board of Educa-tion,
and the North Carolina Medical
Care Commission. The report of the
study by Dr. Ray E. Brown, director
of the General Program in Hospital
Administration at Duke University,
was published in 1964. It included
information on the need for and edu-cation
of nurses in the State and
described the key role which institu-tions
of higher learning, including
community colleges, must play in
meeting the needs for well-trained
nurses at all levels.
General Practitioners Needed
Because so many physicians go into
specialties or research and settle in
the large population centers, the num-ber
in general practice and serving
in community hospitals is insufficient.
Hoping to interest young doctors
to enter general practice in rural
communities, the Endowment has
financed since 1961 a Community In-tern
program for junior and senior
medical students. Some 70 of these
young people spend two months in
the summer as junior interns in par-ticipating
hospitals, gaining experi-
I s»
Illustrative of the work done in the training ot interns, residents, and junior interns in several North Carolina hospitals are these photographs which
were made at the Charlotte Memorial Hospital showing daily teaching rounds (left) and routine daily rounds. The Endowment has financed a
community intern program.
10 ESC QUARTERLY
)nce and knowledge related to general
)ractice and learning of the oppor-unities
it offers. It is essential to
ittract more doctors to this type of
>ractice. Figures from the American
Vledical Association showed that in
.964 North Carolina, with 4,533
)hysicians in active practice, had
•nly 1,303 physicians, or one for each
1,274 of the population, engaging in
general practice.
Another Endowment project di-ected
toward increasing the number
if physicians in general practice was
i forum held at the Duke University
Medical Center in May, 1964, which
vas attended by more than 100 stu-lents
and faculty members. Leaders
n medical education and physicians
trominent in general practice were
peakers.
Graduate medical education is, of
ourse, a most important part of the
raining of a doctor. In recent years
he Endowment has made appropri-ations
to help a number of hospitals
n the State establish Departments
f Medical Education which, in addi-ion
to training their own interns
ind residents, demonstrate to other
lospitals what can be done to make
in educational program most effec-ive.
The success of a hospital in ful-illing
its responsibilities depends in
i large measure upon the abilities
f its administrator. Cooperating
rith Duke University in a program
f Hospital Administration since the
arly 1930s, the Endowment has
ontributed to the training of nearly
00 students who are active in hospi-al
or related fields. Most of these
tudents served administrative resi-lences
with the Endowment. Also,
n the year beginning with 1930, the
Endowment has had assigned to its
Charlotte office more than 200 ad-ninistrative
residents or trainees who
have received one week or more of
orientation, field work, or experi-ence.
Most of these are active in
hospital or related fields.
Since the forum on general prac-tice
was held in 1964, there have been
two others, one on the problems of
multiple-unit hospitals in 1965 and
one on outpatient services in May,
1966. These forums are considered
highly valuable as opportunities for
hospital administrators to- gain
knowledge on subjects of importance
to their work and to exchange ideas
with others who have similar in-terests.
Activities of the Endowment are
directed by its Trustees of whom
Thomas L. Perkins is chairman. Of-fices
are in New York, Charlotte, and
Durham. Centered in the Charlotte
office, which is under the general
supervision of Marshall I. Pickens,
are services to hospitals and child
care institutions. Mr. Pickens is vice
chairman of the Endowment and
has been a Trustee since 1951. With
the Endowment since 1928, he was
executive director of the Hospital
and Child Care sections for 16 years.
Early this year, he relinquished this
office and was succeeded by the assist-ant
executive director, James R.
Felts, Jr., who has been with the
foundation for 23 years.
The staff of the Hospital Section
counsels trustees and executives of
institutions who wish advice on mat-ters
connected with administration,
accounting, new or expanded facili-ties,
or services. Several years ago
it developed a uniform record-keeping
system which enables hospitals to
analyze costs and establish rates, and
for many years it has compiled and
distributed statistical information
which helps administrators evaluate
their own operations by comparing
them with those of other similar in-stitutions.
It often has been said by
administrators that staff services are
more valuable to them than the
money they receive from the En-dowment.
North Carolina hospitals are in a
period of change as they become in-creasingly
important as the health
centers of their communities and face
new demands and growing responsi-bilities.
In this period, as in all the
years since the Endowment was
established, they have the advantage
of being able to benefit from the
knowledge and experience of their
benefactor as well as from its finan-cial
assistance. Because Trustees of
the Duke Endowment have great
concern for the improvement of
health care in the Carolinas, they
combine a program of services with
distribution of financial help and, as
a result, the Endowment is a major
factor in the development of more
adequate facilities for the care of the
sick in the two states it serves.
The ESC Quarterly is
printed in four volumes,
published twice a year.
It is printed under state
contract by the Print Shop,
N. C. State University,
Raleigh, N. C.
i
'&-W
Ski
t the Charlotte Memorial Hospital a teaching member of the visiting medical staff meets with the Pediatrics house staff (left), and an intern and
Jnior intern receive instruction from a teaching member of the attending staff in the Department of Pediatrics.
ESC QUARTERLY 11
M
V@oa
wmws
Ml
Submitted by the
STATE BOARD OF HEALTH
12 ESC QUARTERLY
H,ealth personnel is in short supply.
This is true whether you have in
nind doctors, nurses, health educa-tors,
sanitary engineers, dentists, pub-ic
health nurses or any of the scores
)f health and health related profes-sions.
And the critical situation we face
low in North Carolina and in the
lation will get worse before it gets
setter. Without getting lost in statis-ts,
let's look at the problem.
The situation will get worse for
several inescapable reasons. First of
ill, the population is increasing in
jercentage more rapidly than the
jercent increase in health personnel.
Population increases are greater in
rounger age brackets and in the
)racket above 65 years, the two
groups needing proportionately more
lealth services.
Another reason for the critical
ihortages in health personnel is the
greater expectation of the people for
lealth services. The people hear of
;he amazing day-by-day advances in
nedicine and science, and they want
;he health benefits and want them
tow.
Still another pressure put upon the
jresently available health personnel
s the capacity for training of the
)resent institutions for preparing
ioctors, dentists, public health work-ers,
nurses and the others. These in-stitutions,
like Rome, were not built
n a day, nor were they built without
jreat expenditures of funds. And the
:'unds were not secured without
nonths and even years of considera-
;ion and effort, whether those funds
:ame from private or public sources.
In North Carolina, if an institution
—medical, nursing, public health or
lommunity college—is to receive pub-ic
funds, these funds have to be
luthorized by the General Assembly
vhich meets only every two years,
^nd, once authorized, it takes several
'ears to build any major physical
'acilities, and then the problem of
inding staff members is really faced,
t is not sufficient to merely take
itaff from other institutions which
rain health personnel. This maneu-rer
does not increase the supply of
lealth personnel. So you can see what
he problem is, at least in part.
Multi-Duties
In the health professions, we have
ittle difficulty getting people to take
•rofessional training if we have the
eats in training institutions where
hey can become prepared. We need
nore seats and the teaching staff to
nstruct the students.
Another aspect of the health man-
>ower shortage is the fact that pres-et
manpower is not being used effi-
Medicol personnel of far ranging abilities are needed to man today's modern and fully
equipped intensive care unit (above) and operating room. Note the scrupulous instruments
and technical devices, all requiring the knowledgeable touch of the competent physician,
anesthesiologist, nurse—professions which need intensive training and continuing study.
Dr. Jacob Koomen became Director
of the State Board of Health in May,
1966, succeeding Dr. J. W. R. Norton
who, after 17'/z years, resigned this
position due to ill health.
A graduate of the University of
Rochester School of Medicine, Dr.
Koomen is a native of Bristol, New
York, and was an instructor in
KOOMEN
medicine and bacteriology and assist-ant
physician at the University and
Strong Hospital for five years.
In 1954, Dr. Koomen was assigned
to the N. C. State Board of Health
by the Epidemic Intelligence Service
of the U. S. Public Health Service.
A surgeon, Dr. Koomen subsequently
became Director of Epidemiology for
the State Board of Health, and in
1957 received his Master's degree in
Public Health from the UNC School
of Public Health.
In 1961 he became Assistant Direc-tor
of the Board of Health.
Active in many public health activ-ities,
Dr. Koomen received the
Reynolds Award in 1960 for outstand-ing
contribution in public health in
North Carolina, and holds member-ship
in several national and state
professional associations.
He is the author and co-author of a
number of publications in the field of
epidemiology and holds the rank of
Senior Surgeon (R) in the U. S.
Public Health Service. He is currently
Visiting Associate Professor at the
UNC School of Public Health.
ESC QUARTERLY 13
Job completed! Happy it's over, this young man has had proper
dental care. Dentistry is another medical profession facing shortages
of qualified dental assistants (left) and doctors of dentistry.
In some remote areas of North Carolina, medical services are sparse. Medical
facilities are vitally needed by minority groups, such as this young Indian child
suffering with severe diarrheal disease.
Rehabilitation is a vital service of the medical profession. A public health nurse (left) works
with an elderly stroke victim. Other services are more technical, such as the audiometer
test being given to determine the child's range of hearing (right).
14 ESC QUARTERLY-ciently.
Doctors are having to do
administrative and other tasks in
addition to providing the medical ser-vices
for which they have been spe-cifically
trained. Dentists are similar-ly
burdened. Hospital nurses and
public health nurses and other health
personnel have the same problem.
The introduction of nurses aides
and technicians in many other health
fields to have some of these tasks
assigned to them under professional
supervision is becoming one way of
more efficiently using the present
health manpower. The training of
such aides and health technicians is
a new and important field of endeavor
for the community colleges, and even
to train these aides will take two or
more years after you get the institu-tion
built and staffed.
Too Few
Until now we have not mentioned
Medicare but this massive program
must be absorbed and made to work
with too little time, too few health
facilities and training institutions and
too few trained people to do the job.
With all its acknowledged benefits,
such government action could dilute
the excellence of the present medical,
hospital and other health care which
present facilities and health person-nel
can deliver.
This point is an immediate concern
of some medical leaders. Lowell T.
Coggeshall, MD, Vice President of
the University of Chicago and Chair
man of the panel on Medical Educa
tion at last November's White House
Conference on Health, had this tc
say: "There is a critical manpowei
shortage at all levels." He said the
solution is an adequately trained sup
ply of manpower, even though th(
nation will have to accept the fac
that it can never have enough physi
cians. "Nevertheless," he insisted
"we must increase the number of med
ical schools and increase their size
There is some apprehension that i:j
we aren't careful . . . Congress wil
put laws on the books before we cai
provide the manpower to carry ou
the programs. If that happens, thei
the alternative is crash programs, ant
they are always ill advised and usual
ly poorly conceived."
N. C. Activities
What is North Carolina doing abou
increasing the supply of health man
power?
Every health profession has a re
cruitment program in operation wit
varying results, competing as the
must with other professions and voca
tions, health and non-health related
The activities and contributions o
Health Careers for North Carolins
Inc., is long range and constructiv
nd even now is producing an upward
urn in the recruitment picture.
Health training institutions and
gencies are maintaining standards
nd assuming their share of the re-ponsibility
to provide health man-ower
trained and in sufficient num-ers
to meet our State's need and
lake our proper contribution to the
eeds of the nation.
In summary, the American people
re demanding more and better health
ervices. They want the benefits of
lodern science for the promotion of
ealth and the care of the sick.
We need to take an overview of
ealth manpower involving all the
ealth professions and occupations of
11 levels of skill. This should include
ot only traditional jobs that have
een denned by long experience but
he emerging, new roles and positions
i the developing programs of health
ervice.
The main concern in health man-ower
is not merely to rearrange the
resent health manpower pool, but
3 materially enlarge it.
The pressure of need under which
;e have labored for years has been
ubstantially augmented by recent
evelopments, particularly the ex-anded
health care for the aged which
lready has had tremendous implica-ions
for manpower.
President Johnson in "Advancing
he Nation's Health," his message to
he 89th Congress January 7, 1965,
aid "We must . . . look to the future
i planning to meet the health man-ower
requirements of the Nation.
"Unmet health needs are already
irge. American families are demand-lg
and expecting more and better
ealth services. ... If we are to meet
ur future needs and raise the health
f the Nation, we must improve utili-ation
of available professional health
ersonnel; expand the use and train-ig
of technicians and ancillary
ealth workers through special
chools and under the Vocational
Education Act and Manpower De-elopment
and Training programs;
xpand and improve training pro-rams
for professional and for sup-orting
health personnel; plan ahead
d meet requirements for which the
?ad time is often 10 years or more."
North Carolina must face up to
his critical and urgent problem and
reate and improve and enlist facili-ies,
institutions, training programs,
nd personnel until adequate and
igh quality health care is available
3 all our citizens.
Who will keep you well if we have
ao few trained people to meet the
ealth needs of our growing, expand-ng
population?
Counselor, doctor, hygienist—often the public health nurse is the
only contact some residents of mountain counties have with health
services. Administering to both young and old, the touring public
health nurse demonstrates a dedication very few medical service
workers exceed.
The ink blot test, an invaluable aid to mental health, is given a
youngster by a psychiatric worker. Community mental health centers
and other special programs demand a large number of dedicated
workers and already shortages exist in personnel to administer new
methods of mental health.
The general practitioner, foundation of community medical services encounter ever in-creasing
appointments attempting to communicate between hospital and hospital.
Laboratory technicians (right) are highly trained personnel necessary for the continuing
search for and identification of disease.
ESC QUARTERLY 15
The Moses H. Cone Hospital in Greensboro opened in 1953. Presently there are 17 de-partments
within the Hospital and employment is approximately 750 people in over 100
different occupations.
MOSES CONE OFFERS SPECIALIZED TRAINING
TO MEDICAL AND HOSPITAL PERSONNEL
By Stella Jones
The Moses H. Cone Memorial Hos-pital,
Greensboro, North Carolina, is
a 424-bed, short-term, non-profit, vol-untary
hospital. Its services range in
scope from the Intensive Care Unit
for patients acutely ill to the Pro-gressive
Care Unit for patients who
require the minimal amount of
attention.
The hospital was established in
1911 as a memorial to Mr. Moses H.
Cone by his wife, Bertha Lindau
Cone. Actual construction was not
begun until many years later, and it
was February 25, 1953, before the
hospital opened its doors for the first
time. Since 1953 the hospital has
grown in size and in the scope of
services provided. It is one of the most
well equipped community facilities in
the state.
Renovation of the laboratory has
just been completed at a cost of ap-proximately
$600,000. This more than
doubles the previous amount of floor
space and greatly increases the labo-ratory
services available. The radiol-ogy
department houses a cobalt
therapy unit for the treatment of
cancer and other tumors. Equipment
has been ordered for the installation
of a cardiopulmonary laboratory to
be used in extensive diagnoses of
heart patients. These are but a few
of the steps taken and being taken
at Moses Cone Hospital in order to
keep abreast of the rapid changes in
medicine today.
In all there are 17 departments of
the hospital. Each serves a vital
function in relation to the operation
of the whole hospital. It takes ap-proximately
two and one-half em-ployees
per patient to keep the hospi-tal
running smoothly. This figure
means that there are about 750 em-ployees
filling approximately 100 dif-ferent
job classifications. The oppor-tunities
are great, for such a variety
of jobs insures a variety of people
and a variety of necessary skills.
There is a place for a highly trained
professional and there is also a place
for the person with little formal edu-cation.
Some of the jobs offer training
programs, and Moses Cone Hospital
employs three full-time, in-service
education instructors for this purpose.
This means that in order to fill many
of the hospital positions available
you need not have had any experience
in that type work.
Many Job Opportunities
There is always the much publi-cized
need for nurses. There is, in
addition, a need for persons to fill
jobs such as orderlies, kitchen police,
porters, tray girls, etc. There are jobs
for men and women. Age is no real
deterrent, for the various job classifi-cations
require different aged people.
Employees ranging in age from 18 to
76 years are employed at Moses Cone
Hospital. There are handicapped em-ployees
who are performing their
jobs and performing them well. There
is also a place in the hospital for ex-servicemen,
who by nature of their
military training have acquired valu-able
skills.
The advantages of working in a
hospital are many. Since hospitals are
necessary to the community there is
little chance of suffering a reduction
of the work load with its ensuing
"lay-off." Moses Cone Hospital takes
every precaution to see that its em-ployees
are physically fit for their
jobs. Prior to employment and each
subsequent year, employees are re-quired
to have a serological test and
a chest X-ray. Group hospitalization
and life insurance is available at a
low premium. The salary, sick leave,
vacations and working conditions are
excellent.
Moses Cone Hospital also serves as
a teaching institution, for students
from UNC-G receive their practical
experience in the hospital under close
supervision. Likewise, practical nurs-ing
students from Guilford Technical
Institute also take their practical
training at Moses Cone Hospital. A
similar affiliation is also maintained
with the A & T College School of
Nursing. In addition to these affilia-tions,
Moses Cone Hospital itself of-fers
three schools.
The School of Medical Technol-ogists
operated by the laboratory pro-vides
a one-year course of academic
training with actual work in the lab
where more than 200,000 tests and
analyses are performed each year.
There is also a School for X-Ray
Technicians which accepts a limited
number of graduates from accredited
high schools for a specialized 24-
month training course. Last August a
class for Operating Room Techni-cians
(O.R.T.'s) was established for
graduates of approved schools ofj
practical nursing who desire further}
training in operating room technique.
j
It is hoped that these classes will
help to relieve the shortage of quali-fied
operating room personnel.
Volunteers
In addition to its employees, Moses
Cone Hospital has a vital link with
the community through its volunteer
workers. During the past year a totalj
of 21,104 hours was contributed byj
the volunteers. Of this figure, 12,000
hours were contributed by the Candy
Stripers and Pilots who are the teen
age volunteers.
(See MOSES CONE, page 33)
16 ESC QUARTERLY
Patients Entering Hospitals Today
Have New Prospect of Recovery As
Public and Profession Alike Adopt
New Philosophy Toward Mentally 111
MENTAL HEALTH
By Dr. Eugene A. Hargrove
Commissioner, N. C. Department of Mental Health
Persons choosing a mental health
career today are entering a field of
work that is dynamic and full of
hope and challenge.
This has not always been so.
For a century, beginning with the
establishment in 1856 of the first
State mental hospital in North Caro-lina,
the care of the mentally ill was
a discouraging problem of ever-mounting
patient populations. In the
absence of really effective treatment
methods, patients remained in the
hospitals indefinitely and the accumu-lation
led to overcrowding and a con-tinuing
demand for new buildings and
more beds.
The development of new treatment
methods, particularly the psychotro-pic
drugs, brought about a dramatic
reversal of the established trend
toward rising hospital populations
when in 1956 the total declined
slightly for the first time in history.
The realization that mental illness
can be successfully treated has
brought many more North Carolin-ians
to the state hospitals for treat-ment,
an increasing number of
voluntary admissions. Admissions to
the four hospitals during 1964-65,
for example, totalled 12,561 as com-pared
to only 4,270 patients during
1956-57—an increase of almost 200
percent in eight years.
During the same eight year period
the average daily resident popula-tion
of the four hospitals dropped by
almost 1,000 patients. Patients are
being discharged to their homes and
communities at a faster rate than
they are being admitted.
Bygone Philosophy
Patients entering our mental hos-pitals
today have a new prospect
over the "abandon hope" philosophy
of years ago. No longer need they
be resigned to interminable years of
residence there. In 1962, for example,
58 percent of patients discharged had
hospital stays of two months or less.
By 1964, 75 percent could expect to
leave within two months. Currently
the median length of stay is 32 days.
The state psychiatric hospital of
today is no longer the institution it
once was, a haven or asylum of cus-todial
care which served to isolate
and segregate the mentally ill from
the eyes and consciences of society.
Today our State hospitals have
an entirely different role. The modern
psychiatric facility in North Carolina
is a treatment-oriented medical facili-ty
whose well trained professional
staff offers intensive therapy for both
acute and chronic patients, special-ized
services for groups with special
problems and a comprehensive pro-gram
of rehabilitation services. It is
becoming increasingly a part of the
community, moving into an ever closer
relationship with the homes of the
people it serves. No longer an iso-lated
"human warehouse" of custo-
ESC QUARTERLY 17
The 1963 General Assembly passed
an act creating a State Department
of Mental Health and a State Board
of Mental Health. The new Depart-ment
was given the responsibility
,
under medical leadership, for co-ordinating
and directing all mental
health programs and facilities in the
State, including local community
mental health centers and clinics, four
regional state mental hospitals and
four residential centers for mentally
retarded, and special programs for
alcoholics, emotionally disturbed chil-dren,
and mentally ill inmates of the
State Prisons system. Certain licens-ing
responsibilities are also included.
At the State level in the central
office of the Department eight ad-ministrative
positions are established
by law. They include the positions of
commissioner of mental health, gen-eral
business manager and five deputy
directors. One deputy director has
responsibility for all retardation pro-grams,
including the four residential
centers as well as community pro-grams.
A deputy director serves each
of four mental health regions of the
State: western, north central, south
central and eastern, each containing
a regional mental hospital and a
number of community mental health
programs.
The cotnmissioner of mental health
also administers programs in profes-sional
education and training, re-search,
statistics, mental health edu-cation,
professional services and plan-ning.
dial care, it is developing into a
dynamic link in a network of in-patient
and outpatient services
which seeks to provide a program
of continuous, comprehensive psychia-tric
care when and where it is needed.
For Mentally Retarded
In addition to the mental hospitals,
the North Carolina Department of
Mental Health operates four resi-dential
centers for the mentally re-tarded
located in Morganton, Butner,
Kinston and Goldsboro.
Mental retardation is a deficiency
of intellectual capacity usually pres-ent
at birth and often associated
with severe physical disability. It is
a problem different in many ways
from mental illness and with few ex-ceptions
is not reversible, even with
the most intensive treatment. For
this reason the encouraging increase
in discharges and reduction of patient
population which has occurred in the
mental hospitals has not taken place
in the State centers for retarded.
Since 1962, for example, an in-crease
of 50 percent in patients under
care in the State centers for re-tarded
has been noted. Much of this
increase is attributable to additional
beds. Western Carolina Center in
Morganton, with 600 beds, opened in
1963. Several new cottages were built
at O'Berry Center in Goldsboro.
In the retardation centers, admis-sions
are rising, discharges are not
keeping pace and the retarded popu-lation
is therefore growing. That
there is still an unmet need for resi-dential
care is evidenced by sizeable
waiting lists which exist at all of the
State's centers.
As North Carolina communities are
able to develop more resources, such
as special education classes, sheltered
workshops, rehabilitation houses, and
day care centers, it is expected that
more and more of our mildly retarded
children will be able to remain at
home. However, normal growth of
the general population along with de-creased
infant mortality is bringing
increasing numbers of severely re-tarded
and multiply handicapped
children into the State centers. In
response the four facilities will in-creasingly
become centers for long
term intensive care of the severely
handicapped. There will at the same
time be fewer of the mildly and mod-erately
retarded, who have a better
chance of returning to the community.
But even in working with the
severely handicapped, the staffs of the
centers reject a custodial philosophy
of care. There is a growing emphasis
on rehabilitation, education and train-ing
within the limits of each retarded
resident's capacity. Dedicated staff
personnel work with a sense of pur-pose
and an air of optimism. The ob-jective
of North Carolina's mental
retardation centers is to help each
individual resident develop to his
maximum capacity and to become as
happy and as self-sufficient as his
handicaps will allow.
Remarkable Growth
Accompanying the expansion of
services to the hospitalized mentally
ill and retarded has been the rapid
growth and expansion of mental
health services through the community
mental health clinics.
At present, 34 community mental
health clinics and 17 satellite pro-grams
provide service coverage to 51
counties in the state. Considering that
at the close of 1961 there were only
12 clinics and 11 satellite programs,
this is a remarkable rate of growth.
Patients under care in the mental
health clinics totalled more than
22,000 during fiscal 1965, compared
with only 8,356 patients seen in the
clinics during 1962.
The Department of Mental Health
is committed under its Comprehensive
Mental Health Plan to participate
with Federal and local governments
in constructing new comprehensive
mental health centers in 27 areas of
the State, each comprising a popula-tion
base of between 75,000 and
200,000 people. This expansion is
projected over a period of several
years, but will eventually require the
services of scores of additional trained
personnel, particularly psychiatrists,
social workers, psychologists and
mental health nurses.
The community mental health center
is staffed by psychiatrists, psychol-ogists
and social workers, each
contributing his unique skills within
the context of the "team approach."
Typically a psychiatrist serves as
director of the center and assumes
medical responsibility for the diag-nostic
and treatment services afforded.
The psychiatric social worker assumes
responsibility for coordination with
other community agencies and pro-vides
the social history for the
patient. The clinical psychologist
administers intelligence tests and pro-jective
techniques of personality
evaluation as indicated. All team
members in conference with each
other and with representatives of
allied agencies when appropriate,
arrive at a diagnosis and treatment
recommendation. The patient is then
assigned to a member of the team
for treatment, while family members
Of the more than 10,000 patients dis-charged
from State hospitals last year,
many are referred to the outpatient clinic
for followup care and maintenance of drug
dosage. Inpatient and outpatient services
provide continuous phychiatric care.
18 ESC QUARTERLY
ire counseled by another worker.
\iter certain treatment objectives
ire reached, referral of the patient to
mother agency may be made.
In addition to direct services to
jatients, the centers increasingly of-fer
consultation to other professional
lisciplines who meet with mental
lealth problems in their professional
pursuits and who can be helped to
leal more effectively with this aspect
>f their work. Among the principal
groups using mental health consul-
;ation are teachers, general practition-ers,
public health nurses, and welfare
:aseworkers.
Further indirect service to adults
md children is offered by community
nental health personnel in the pro-vision
of information and education
services to the general public and
nservice training for professional
groups. Thousands of hours of pro-fessional
time is devoted to these
;hree major types of community
services by mental health center
workers, in addition to their treat-nent
function.
More Personnel Needed
To carry on all the far ranging
work of the Department of Mental
Health—operation of the State hos-pitals,
the centers for retarded, com-munity
mental health centers, and
)ther special programs—demands a
arge and dedicated corps of person-
HARGROVE
When the Department of Mental
Health was established in 1963, Dr.
Eugene A. Hargrove, who had been
director of the Hospital Board of
Control since 1958, was appointed
Commissioner of the new State
agency.
A clinical professor of psychiatry
at the University of North Carolina,
Dr. Hargrove holds AB and MD
degrees from the University of Texas.
He performed his internship at the
General Hospital in Denver, Colorado
and his residency in psychiatry at the
Clarkson Hospital, Omaha, Nebraska.
From 1947-48 Dr. Hargrove was a
Fellow in Psychiatry at the Institute
of Nervous and Mental Diseases in
Philadelphia and at the University
of Pennsylvania from 1948-50.
He was certified as a Diplomate by
the American Board of Psychiatry
and Neurology in 1950.
The Mental Health Commissioner
has had teaching experience at the
schools of medicine at the universities
of Pennsylvania, California and
North Carolina.
Member of nearly a dozen profes-sional
associations and organizations,
Dr. Hargrove served in the Army
Medical Corps during World War II.
He is author of a book, "The Practice
of Psychiatry in General Hospitals,"
and numerous papers on psychiatric
studies.
Psychiatric nursing affiliations exist in
each of the State psychiatric hospitals,
allowing undergraduate student nurses from
hospital nursing schools statewide to re-ceive
part of their training in a psychiatric
setting. For physicians, fully approved
three-year residency programs are in op-eration
in two psychiatric hospitals.
nel. We are fortunate in that our
personnel possess the required dedi-cation
in liberal measure. But even
though we currently employ roughly
6,800 persons in all phases of mental
health work, a great many more
personnel are needed, particularly
those directly responsible for patient
care and treatment.
In the psychiatric hospitals, for
example, we are setting as a goal
the achievement of full accreditation
by the Joint Commission on the Ac-creditation
of Hospitals. In order to
achieve accreditation standards in
personnel, we estimate that the fol-lowing
additional trained personnel
will be needed:
Psychiatrists 21
Psychologists 23
Registered Nurses 365
Social Workers 99
Rehab. Workers 72
Dentists 3
In addition many more ancillary
personnel — laboratory technicians,
medical records assistants, X-ray
technicians and others—will be needed
to achieve accreditation and the
accompanying improvement in patient
care and treatment which will result.
While these positions are not cur-rently
budgeted, they will be included
in the next biennial budget request
of the Department of Mental Health.
Many more professional workers
will be needed in the future to staff
the new and expanded network of
community mental health centers. It
is estimated that a total of 80 psychi-atrists,
80 social workers, and 80
psychologists will eventually be
needed to provide treatment teams
in each of the community centers.
Many of the larger centers serving
more heavily populated areas will
need to employ several treatment
teams.
In the mental retardation centers,
urgent personnel needs are for
more doctors, psychologists, physical
therapists, occupational therapists,
nurses, recreators, teachers and cot-tage
parents.
To Train Its Own
Throughout the mental health field
the key to better patient care is more
and better trained personnel. Patient/
personnel ratios are still much too
high, although it is a tribute to pres-ent
personnel that so much has been
accomplished under limitations of
staff time.
The question which comes to mind
next is, "Where are the additional
professional personnel to be found?"
Trained mental health manpower is
in critically short supply all over the
country.
As one answer to the manpower
shortage, the Department is seeking
to "grow our own" personnel through
training programs carried on either
within the State mental health system
or in collaboration with academic
institutions. Following are some
examples of these training programs.
Fully approved 3-year residency
training programs are in operation
in two of the four psychiatric
hospitals. Currently 32 physicians are
taking their psychiatric training in
these programs. Experience shows
that many of these residents will
continue to work within the State
mental health system upon completion
of training.
ESC QUARTERLY 19
A research psychiatrist and his assistant work to close some of the gaps in knowledge about mental illness which still exist, frustrating
efforts at cure and prevention (left). In service training programs (right photo) for all mental health employees provide each with the
opportunity for furthering self-development and keeping up with new concepts and advances in the field. Hospitals and centers for
retarded have continuing education programs for aides, attendants and cottage parents.
Serving four admission areas in North Carolina and administered by the N. C. Department of Mental Health are John Umstead Hospital
in Butner (upper left); Broughton Hospital, Morganton; Cherry Hospital, Goldsboro (bottom left); and Dorothea Dix Hospital in Raleigh.
Patients admitted to the four hospitals during 1964-65 totalled over 12,500. Also there are presently 34 community mental health clinics
in the State in which patients under care in fiscal 1965 totalled over 22,000.
20 ESC QUARTERLY
John UmiteadHotpitol
)
/s y -
' —4
H r-
I
„,..,... i „
-4 -|—•
-7~r
l—i— /
1
—'i >^J>
^ K^ < .w ~~ i J
\~
HOSPITAL ADMISSION AREAS |R..i.*d July I. 1965)
I E.ilud.ng m«inll r III criminal.)
NORTH CAROLINA STATE DEPARTMENT OF MENTAL HEALTH
Psychiatric nursing affiliations
:xist in each of the psychiatric hos-jitals,
allowing undergraduate stu-lent
nurses from hospital nursing
ichools all over North Carolina to
eceive part of their training in a
)sychiatric setting. Many of these
students return after graduation to
ill positions as staff nurses in one
>f the State facilities.
For graduate nurses, a program of
)eriodic postgraduate seminars is
leld, in conjunction with the State
iniversity school of nursing.
Mental health facilities have devel-
>ped into field training resources for
)sychiatric social work students. Stu-lents
in the School of Social Work,
University of North Carolina, are
issigned field work placements in a
lumber of the Department's inpatient
Mental hospitals have had to develop a
wide range of medical services. Here a
physical therapist works with a paralysis
victim.
units and in several of the community
mental health clinics.
A number of the community mental
health centers provide training for
the mental health disciplines, includ-ing
graduate students in psychology;
psychiatric social work; and psychi-atric
residents.
In-service training programs for
all employees provide each one the
opportunity for furthering self-development
and keeping abreast of
new concepts and advances in the
field. Hospitals and centers for re-tarded
have continuing education pro-grams
for aides, attendants and
cottage parents. Appreciation of the
value of these workers as they inter-act
with patients has led to a
recognition of the need to develop
further their therapeutic potential.
Training programs for aides and cot-tage
parents are becoming more
sophisticated and comprehensive under
the stimulus of federal grant funds
being utilized for their development.
In-service training programs for
other professional staff members, in-cluding
workshops, seminars and
visiting lecture series are held
regularly in all Departmental facili-ties.
Work-Study Programs
Another potentially rewarding effort
is the work study program begun at
Dorothea Dix and John Umstead
Hospitals in collaboration with Duke
University, North Carolina College,
North Carolina State University and
St. Augustine's College. Participating
students work part-time in the hos-pitals
while pursuing their academic
programs, with the Federal govern-ment
bearing nine-tenths of the cost.
North Carolina is fortunate in
having a well-supported program of
educational loans, administered by
the Medical Care Commission, for
medical and related studies, including
mental health related fields. These
include medicine, nursing, social work,
clinical psychology and occupational
therapy. The loans are usually repaid
by exchanging one year of paid serv-ice
within the State mental health
system for each year of scholarship
support, but they may be repaid
directly with interest.
These are some of the ways in
which we are attempting to attract
and keep competent, trained person-nel
within the mental health field.
Programs of recruitment and training
will have to continue to grow and
creative new approaches to the man-power
problem must be tried if the
needs of North Carolina's mentally
ill and retarded for better care and
treatment are to be met.
Familiar to the public's concept of psy-chiatry,
a counseling interview is held.
Here a patient meets with members of the
treatment team.
ESC QUARTERLY 21
Mentally Retarded Children Need
Special People, Special Services
By Dr. J. Iverson Riddle, Superintendent
Western Carolina Center
Western Carolina Center is the
State's newest residential facility for
the care and treatment of mentally
handicapped children. Its basic ap-proach
to children encompasses the
realization that children must remain
with their parents, or as close to
them as possible, if they are to grow
to their maximum both mentally and
physically. The Center's goal is to
return as many patients as possible
to their homes and communities. For
those who because of the nature of
their handicap cannot return home,
the goal is to help them to be as
happy as possible day by day.
The Center serves the western 30
counties of North Carolina, and is
striving daily to be a part of each
area and community with which it
works. There is no wal] surrounding
it, visible or invisible. Visiting is
actively encouraged. In keeping with
this policy, there are no visiting
hours or regulations. Visitors are
asked to sign a log so that the staff
may know which children are not
being visited. In these cases, volun-teers
arrange to visit in order that
no child will feel lonely or neglected.
The staff now numbers 340 and is
composed of physicians, nurses, secre-taries,
business personnel, mainte-nance
crews, occupational therapists,
physical therapists, food handlers,
school teachers, recreators, rehabili-tation
counselors, industrial thera-pists,
psychologists, and social work-ers.
The Center also has the services
of a fulltime chaplain.
The recreators help the entire staff
to realize that play is the language
North Carolina's newest residential facility for the care and treatment of
mentally handicapped children, Western Carolina Center serves 30 western
Tarheel counties.
of childhood, and that it is often only
through play that children can be
reached. Volunteer groups as well as
individuals have helped supply toys
A project has been proposed whereby
volunteer craftsmen from the sur-rounding
furniture industries car
gather at the Center in a special
workshop to fabricate special toys foi
special children.
Trained At Center
Perhaps one of the biggest tasks
has been the recruitment of staff foi
the new facility. There is a shortage
of personnel in the field on bott
the professional and subprofessional
levels. No matter how competent those
who are recruited happen to be, they
still must be trained to work witli
mentally handicapped youngsters. The
local and area Employment Security
agencies have worked closely with
the Center's staff in both the location
and training of staff. Two hundred
and twenty-five cottage parents (at-tendants)
have been trained at the
Center in cooperation with the local
Employment Security Commission,
using the Manpower Development and
Training Act as the training vehicle.
The cottage parent trainees were
located, and in classes of 15 to 20
were trained for 400 hours. The
trainees were carefully screened be-fore,
during, and after training. Of
the 225 who were trained, approxi-mately
170 remain on the job aftei
nearly three years. The turnover rate
has, therefore, been about "0 percent.
The staff is now studying records oi
those who have left, in order to gair
a better understanding of the various
factors that influence the turnovei
rate.
Most Pressing Problem
The Center faces many problems as
it seeks new means for providing
service for western North Carolina':
mentally handicapped children. Th«
most pressing problem is the short
Buildings at Western Carolina Center are modern, well equipped and the grounds are spacious. Over 340 persons are employed at the
attractive institution, but already it is facing a serious shortage of qualified personnel. Special training is required to qualify individuals
to work with handicapped children.
ESC QUARTERLY
ige of personnel. On some shifts, one
ottage parent may be called on to
:are for 72 children. Very often the
:ottage parent works with as many
is 36 children. Additional personnel
vould make it possible to offer the
cind of treatment programs that
;hese children need and deserve. An
ncrease in personnel would be a
sound investment for the people of
tforth Carolina. It has been calculated
;hat when a child is returned to his
community from a residential facility,
;here is a savings to the taxpayer of
nore than $100,000.
Winning over the parents of the
children to new programs is always
i busy task for staff members. Be-
:ause of fears and lack of knowledge,
nany of the parents remain at a
listance. Ways must be found to
nake visiting more enjoyable for
;he parents and their child. They
nust be encouraged to actively sup-port
programs for all handicapped
children.
Probably the greatest problem faced
jy those working with mentally
landicapped children is that of "seg-nentation
of service." We are be-coming
more aware each day that
;hese children are multiply handi-capped,
and, consequently, require
services from many people of special
;raining and experience. There is a
nultitude of agencies and profession-als
becoming involved in the field,
rhere must be more effort made
toward working together, as well as
sharing information and services.
Agency boundaries must be relaxed if
a closer relationship among those
wishing to give services is to be
developed.
The Staff hopes visitors to the
Morganton area will make it a point
to visit the Western Carolina Center.
COMMENTS
(Continued from Page 2)
The articles published in this spe-cial
health-service edition of the ESC
Quarterly give us the history, growth
and needs of North Carolina's major
private and public medical institu-tions.
The shortage of trained workers in
the health service industry has caused
a sincere and growing concern among
professional people, educators, state
and federal agencies. It is evident
that training programs for health and
related professions need to be expand-ed,
and a great deal of public aware-ness,
especially among our young
people, needs to exist about the short-age
and the opportunities caused by
it. Whether enough national empha-sis
can be brought to bear, or whether
enough state and local initiative can
be generated to cope with the imbal-ance
of worker supply and demand
is yet to be seen.
Medical technologist in the Bacteriology Laboratory studying the sensitivity
of bacteria to various antibiotics.
Medical Technologists Perform
Hundreds of Laboratory Tasks
By Sarah Sands, M.T.(ASCP)
N. C. Society of Medical Technologists
Today the need for young people
in the field of medical science is at
its highest peak in the history of
medicine. Medical technology is one
of the newer para-medical fields, but
it is one of the most important and
fastest growing of the professions
which compose the medical team.
The hospital patient may know the
medical technologist only as the girl
or boy "who took my blood." But
the medical technologists play a much
greater role in the life-and-death
drama which occurs in hospitals, phy-sicians'
offices and research labora-tories.
They carefully and accurately
perform hundreds of laboratory pro-cedures
which ferret out the cause of
a pathological condition or identifies
the offender in an infectious disease.
The results of the tests performed
in the laboratory on body fluids and
tissues provide the clues to functional
changes brought about by disease.
Test results may reveal the existence
of a disease which was unsuspected
by the physician or the patient. Often
the tests are emergency procedures
such as the preparation of blood for
a transfusion, the determination of a
blood sugar level on a diabetic, or
the preparation of a quick frozen
paper thin section of tumor tissue for
examination by the pathologist who
reports his findings to the waiting
surgeon. Anytime during the day or
night the medical technologists may
be called upon to run a series of stud-ies
on an infant to determine if he
has an Rh problem which may re-quire
an exchange transfusion or to
study a spinal fluid to aid in the diag-nosis
and cause of spinal meningitis.
Fact Finding Tests
The medical technologists run a
battery of fact finding tests often
using highly complicated precision
instruments. The chemical procedures
executed may indicate liver damage,
kidney malfunction, abnormal salt
and mineral concentrations in the
body, the blood level of a drug follow-ing
therapy, the presence of alcohol
and many other anomalous conditions.
They type and cross-match blood for
transfusions and identify complicat-ing
blood antigens and antibodies in
transfusion reactions. They isolate
and identify bacteria which cause
infections and run a variety of tests
on serum that indicate infectious
processes. They cut tissue sections
transparently thin so the pathologist
may study them for abnormal cells
such as those that occur in cancer.
They count and study blood cells and
carry out many hematological studies
which aid in the detection of blood
diseases such as leukemia. They run
urinalysis and search for blood and
intestinal parasites. They perform
electrocardiograms for the detection
of abnormal cardiac impulses and
ESC QUARTERLY 23
Using a Microtome in the Histology lab,
a medical technologist cuts tissue sections.
electroencephalograms for the deter-mination
of brain wave patterns.
In recent years many medical re-search
laboratories have been estab-lished
and efforts have been concen-trated
on determining the cause, cure
and prevention of all types of patho-logical
conditions. With the publica-tion
of each new medical and scien-tific
journal, the medical technologists
find that new procedures have been
developed and improved methods for
laboratory studies have been devised.
The variety of tests are numerous
and oftentimes the procedures are
very complicated, but the results of
such tests are great aids in the early
and accurate diagnosis of disease.
The practice of modern medicine
would be impossible without depend-able
laboratory tests.
Though the profession of medical
technology had an humble beginning,
the need and demand for the labora-tory
worker has increased greatly
and the individuals presently in this
field must be highly trained and
skilled to understand and carry out
these laboratory procedures.
First School at Johns Hopkins
Before World War I most physi-cians
did the small amount of labora-tory
work required on their patients.
As medical knowledge widened, new-er
and more elaborate procedures
were developed and physicians no
longer had the time to perform ade-quate
laboratory studies; thus they
began to train assistants for this
work. Perhaps the first "school" for
training these assistants was at Johns
Hopkins University and the develop-ment
of subsequent schools of train-ing
reflected the growing recognition
of doctors throughout the country
for the need of laboratory studies in
their medical practice. At the present
time there are approximately 800
approved schools of medical tech-nology
in the United States. The
schools are located in various clin-ical
pathology laboratories of hos-pitals
and medical schools throughout
the country and many of them are
affiliated with a college or university
in a degree program.
The approved schools for the train-ing
of medical technologists are
operated under the auspices of the
American Medical Association. In
1928 The American Society of Clin-ical
Pathologists established the
Board of Registry of Medical Tech-nologists
to certify qualified person-nel
in this profession. Medical tech-nologists
and pathologists serve on
this Board which examines and cer-tifies
graduates of medical technology
schools. A Board of Schools of Medi-cal
Technology to institute the edu-cational
standards for the training of
medical technologists was also organ-ized.
The schools which meet the
standards set up by these Boards
receive the official endorsement of
the Council on Medical Education and
Hospitals of the American Medical
Association and are known as AMA-approved
schools of medical tech-nology.
In North Carolina there are 15
AMA-approved schools for the train-ing
of medical technologists. They are
located in Asheville, Chapel Hill,
Charlotte, Concord, Durham, Gastonia,
Greensboro, High Point, Raleigh,
Wilmington and Winston-Salem.
To qualify for the 12 consecutive
months of training in an AMA-ap-proved
school of medical technology
a student must have a minimum of
three years of college background
which includes the successful com-pletion
of 90 semester hours with a
minimum of 16 semester hours in
chemistry, 16 semester hours in the
biological sciences and 3 semester
hours in math. Some schools for
training medical technologists require
that their students have a college de-gree
before entering their clinical
year of training. Advanced courses
in chemistry, biology, math and phy-sics
are strongly advised. Recom-mended
electives include a broad gen-eral
education in English, the social
sciences, arts and humanities.
National Examination
After the completion of college
studies and the year of clinical train-ing
the students must pass the na-tional
examination given by the
Registry of Medical Technologists of
the American Society of Clinical
Pathologists. The Registry is the only
qualifying board for medical tech-nologists
recognized by professional
groups such as the American Medi-cal
Association, the American Soci-ety
of Clinical Pathologists, the
American College of Surgeons, the
American Hospital Association and
other authoritative medical groups.
A medical technologist collects a blood sample (left), and manipulates an advance microscope. These technicians must be highly skilled and
there are 15 AMA-approved schools to qualify medical technologists in North Carolina requiring T2 months of consecutive training.
24 ESC QUARTERLY
SANDS
Since 1961 Sarah Sands has served
is a full time Associate Professor in
he Department of Biology, Univer-sity
of North Carolina in Greensboro,
'n addition to her regular teaching
luties, she has been engaged in re-search
work concerning bacterio-jhages
of certain bacteria of medical
nterest. The research studies have
>een supported through grants from
he National Science Foundation.
A graduate of Salem College in
1945, Miss Sands completed training
n the School of Medical Technology,
Bowman Gray School of Medicine,
rVinston-Salem, and obtained a Mas-er's
degree in Bacteriology at the
Medical Units, University of Ten-lessee,
Memphis, Tenn.
She instructed in the Department of
3athology and Bacteriology at the
University of Tennessee Medical
School, 1950-1953, and subsequently
spent six months with a research
earn in Japan. Miss Sands returned
:o North Carolina in 1958 to teach at
he University of North Carolina in
jrreensboro and has been associated
vith the Department of Pathology,
Moses Cone Memorial Hospital.
The successful completion of train-ing
and attaining competent Regis-try
examination scores indicate that
the students are qualified profession-ally
as laboratory technologists and
are identified as Registered Medical
Technologists who are entitled to use
the letters MT(ASCP) after their
name.
Newer Specialties
There are several areas of certifi-cation
for specialties related to med-ical
technology. Different examina-tions
and different educational back-grounds
are required for the various
specialties. In bacteriology and chem-istry,
board certification is available
to college graduates who have ma-jored
in bacteriology or chemistry and
have had at least one year of expe-rience
in that field or who have ob-tained
a Master's Degree in one of
these sciences. Blood banking is an-other
area of specialization and this
requires an additional year of train-ing
after certification as an MT
(ASCP). Among the newer special-ties
are cytotechnology, the study of
exfoliative cells of the body in the
detection of abnormal cells which
may indicate the presence of cancer,
and nuclear medical technology which
involves the use of radioisotopes in
the study of vital functions.
Among the many well recognized
scientific journals available are two
which specifically provide information
to the medical technologists. The
Registry of Medical Technologists of
the American Society of Clinical Pa-thologists
publishes and distributes
the Technical Bulletin of the Regis-try
of Medical Technologists to all
registrants. The American Journal
of Medical Technology is published by
the American Society of Medical
Technologists, an organization which
was established in 1933 by registered
medical technologists.
Annually the American Society of
Medical Technologists convenes for
a week of workshops and refresher
courses. They hear scientific lectures
by outstanding investigators in the
various phases of laboratory medicine
and participate in scientific discus-sions
as well as present papers on
original work. These educational pro-grams
are also promoted through
state, district and local medical tech-nology
organizations to help the
medical technologists keep abreast of
the many advances in the ever pro-gressing
field of clinical medicine.
The North Carolina Society of Med-ical
Technologists holds a fall sem-inar
and spring convention each year.
These professional organizations
are devised to promote the profes-sion
of medical technology, to main-tain
the high standards and ideals of
this profession, to serve as a con-tinuing
means of education for lab-oratory
personnel and to aid in re-cruiting
and encouraging young
people to enter this profession.
Scholarships are available through
state and national organizations and
from federal funds to assist these
students with expenses during their
training.
Shortage of MT Personnel
There are over 37,000 ASCP Reg-istered
Medical Technologists in the
U. S. today. Approximately 10,000
of these are members of the Ameri-can
Society of Medical Technology
and the total membership in the
North Carolina Society of Medical
Technologists exceeds 200 this year.
Though membership in these organi-zations
has grown tremendously in
recent years, there are far from
enough Registered Medical Technolo-gists
to meet the need and demand
in the laboratory facilities in the
U. S. A recent survey of medical per-sonnel
in North Carolina revealed
(See MED TECH, page 33)
The scientific skills of bacteriology study (left) and the technical methods of chemistry (right) come under the adroit hands of the
trained technologist. Certification for registered medical technologists is available in newer specialties such as chemistry and bacteriology.
To certify, a technologist must hold a master's degree in one of the fields or hold a bachelor's degree with one year experience.
ESC QUARTERLY 25
FEDERAL-STATE FUNDS CONSTRUCTED
240 HOSPITAL PROJECTS SINCE 1947
created as an agency to serve hospi-tals
and related medical facilities in
somewhat the same way as the Board
of Education is related to public
schools and the Highway Commission
to the State's road system. The Com-mission
is broadly responsible for
three main programs: (1) The con-struction
of medical facilities using
By William F. Henderson
Executive Secretary, N. C. Medical Care Commission
With stimulus from federal funds
available under the Hill-Burton Act
inaugurated in the mid-40's and with
special State appropriations, hospitals
and related facilities have expanded
in the two decades beyond any com-parable
period in the State's history.
Under this program, the Medical
Care Commission has inaugurated 422
medical facility projects costing ap-proximately
$300 million. In a number
of projects, North Carolina has con-structed
more hospital and health
facilities under the Federal program
than any other state. Since 1947,
approximately 240 hospital projects
have been constructed involving al-most
13,000 beds.
In 1947, when the construction pro-gram
actually got underway, North
Carolina had some 9,000 general hos-pital
beds. There are now either
existing or under construction 18,500
general beds, an increase of over 100
percent. Including beds in special
hospitals, federal, tuberculosis and
mental facilities, the State upon the
completion of units under construction
will have a total of 33,000 beds. In
addition, the Commission has con-structed
88 public health centers
throughout the State. There are
presently under development contracts
totalling $80 million.
With the advent of Blue Cross and
other hospital insurance programs
and with the increasing availability
of modern medical facilities, utiliza-tion
has continued to rise. For ex-ample,
in 1947 the average percentage
of occupancy of North Carolina hos-pitals
was about 72 percent of capac-ity.
Occupancy is now running over
75 percent in spite of all of the
building that has been accomplished
during the 20-year period. This dra-matic
expansion of facilities obviously
has demanded more people to staff
our growing health services. The
Duke Endowment reported that in
1947 its assisted hospitals in the State
had approximately 8,000 full-time
employees. During that year, these
hospitals provided 2,245,000 adult
days of care requiring 1.3 employees
per inpatient per day. The En-dowment
reports that in 1964 the
hospitals assisted during that year
provided 4,334,000 adult days of care
and employed 26,000 people full time,
or 2.2 employees per inpatient per
day. Thus, during the two decades,
employment has more than tripled.
However, the alarming increase in
unfilled positions, sometimes neces-sitating
the closing of beds, has
accelerated emphasis upon the recruit-ment
and training of literally thou-sands
of more people than are pres-ently
available to staff existing
programs—to say nothing of the
facilities under construction and in
planning.
Student Scholarships
Conscious of the acute shortage of
personnel, the Commission has ex-panded
its program for assisting
students in the medical and related
professions. For years, the Commis-sion,
using State appropriations, has
provided loans to needy students of
medicine, dentistry, pharmacy, nurs-ing
and related fields of study who in
accepting the loans agree to practice
in rural areas, mental hospitals and
other specified health programs within
the State where there are critical
shortages. Because of the growing
acuteness of the problem of obtaining
sufficient personnel, the Commission
recently modified the program to for-give
the loans to those recipients who
practice in North Carolina on the
basis of the cancellation of an aca-demic
year's loan for each calendar
year of service. Other professional
areas of study have been added to
include public health, physical and
occupational therapy, social work,
psychology, dental hygiene, dietetics,
medical record library science, medical
technology, nurse anesthesia, medical
recreation and optometry. As a result
of this modification, applications for
educational assistance under the pro-gram
increased almost 200 percent
during the past year.
Three Main Programs
The Medical Care Commission was
Executive Secretary of the North
Carolina Medical Care Commission
is William F. Henderson, a 1935
graduate of the University of North
Carolina. He attended the UNC
graduate school in 1937 and 1938.
Up to 1939, Henderson was a
public welfare worker in North Caro-lina
and then joined the Children's
Home Society at Greensboro as
Associate Superintendent. Following
World War II, he held several
hospital administrative positions, in-cluding
the Onslow County Hospital
at Jacksonville and the Moore County
Hospital at Pinehurst. In 1952,
he joined the staff of the Medical
Care Commission as Hospital Ad-ministrative
Consultant and became
Executive Secretary of the Com-mission
in 1958.
He is a member of the N. C. Hos-pital
Association, a member of the
Board of Directors of the American
Association for Hospital Planning and
is Secretary of the Association of
State and Territorial Hospital and
Medical Facilities Survey and Con-struction
Authorities.
26 ESC QUARTERLY
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The Forsyth '
Salem, complet
the Hill-Burton
General Hospital, Wlnston-ed
in 1963 with funds from
Act.
Federal and State grants-in-aid in-volving
hospitals, diagnostic and
treatment centers, long-term care
facilities, public health centers, re-habilitation
facilities, mental health
centers and facilities for the mentally
retarded. In this connection, it assists
hospital planning councils with
federal grants, conducts research
projects to benefit the over-all per-formance
of hospital construction
and maintenance. (2) The licensing
of hospitals. State law requires that
hospitals meet certain codes of con-struction
and operation and periodic
surveys of some 170 hospitals in the
State are made to determine compli-ance
with recognized standards. (3)
Student scholarship fund. This section
provides educational assistance to
students in the medical and para-medical
areas in return for service
to the State. Through its scholar-ships,
the Commission assists rural
communities, mental and other public
health and hospital programs in
attracting physicians and other health
specialists to practice in areas of
acute shortages and cooperates with
educational institutions in providing
grants for students in the health
professions.
Grace Hartley Memorial Hospital, Banner Elk
Wake County Health Center, Raleigh
1 i
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. I «W Kpw
ifi p «
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I* I 1
M. 1 !
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Wilson Memorial Hospital, Wilson
Albemarle Hospital, Elizabeth City
CHARLOTTE COMPANY
HAS LONG SERVICE TO
DENTAL PROFESSION
The dental profession has been
using cotton pellets, cotton balls, and
dispensers made by Richmond Dental
Cotton Company since 1895, the busi-ness
having been originated in Niag-ara
Falls, New York, by Dr. Albert
Richmond.
The firm later was managed by
Miss Muriel Berkinshaw and the in-terests
maintained in Niagara Falls
until 1947. Carolina Absorbent Cot-ton
Company of Charlotte, N. C.
(subsidiary of Barnhardt Manufac-turing
Company selling to the medi-cal,
hospital, and industrial fields),
supplied the cotton for many years.
It was only natural, when Miss
Berkinshaw and her associates de-cided
to retire in 1947, that the com-pany
be offered to the Barnhardt
interests.
The time lapse in moving the per-sonnel
and machinery from Niagara
Falls to Charlotte was only two
weeks. The original firm name had
been retained and cotton pellets cot-ton
dispensers were, in 1947, still the
only Richmond Dental items.
The dental business was new to
the Bernhardts, and for a while their
only contact with the profession was
at dental meetings. After working
extensively with dental dealers, it
wasn't long until they discovered that
the demand for Richmond items was
even greater than anticipated.
In 1952, cotton rolls were added to
the Richmond line. The very absorb-ent
rolls are all-cotton, held by braid-ed
threads, having no starchy coating.
Constant advertising to the dental
profession and trade and at dental
convention exhibits created a large
demand for this new item within a
short time.
In August, 1953, the company was
incorporated in the State of North
Carolina.
The manufacturer has since added
to the line: exodontia sponges (plain
gauze and cotton-filled gauze) , cot-ton-
tipped applicators, and tissue
wipes.
The coveted Army-Navy "E" was
awarded to the entire Barnhardt or-ganization
early in 1943 for its splen-did
war-time record.
ESC QUARTERLY 27
GASTON MEMORIAL NEEDS MORE SPACE, PERSONNEL
By Gladys Stenstrom
Cold facts, bed and space shortages,
lists of statistical information, a tight
labor market, and personnel problems
sometimes seem a little out of place
in the mind's-eye picture of a com-munity
hospital. For this is where
we go when we are sick, and although
"tender, loving care" has become a
worn cliche, what we want when we
are sick is exactly that, supported by
good quality service, and all the pro-fessional
skill we can get.
The primary function of a hospital
is, of course, to offer the best possible
patient care to the sick and injured
who enter its doors, and Americans
have come to expect this. To provide
this type of hospital care, television
dramas to the contrary, many un-dramatic
aspects work together in
the behind the scenes activities. The
variations involved in the hospital can
be seen in the personnel office where
there may be openings at one time
for a printer, janitor, anatomy in-structor,
pot washer, medical librar-ian,
or a laundry manager. The need
for nurses is ever present.
Reflects the Community
A hospital is in one sense a mirror;
it reflects the community it is serving.
The changes that occur in the local
population, industry, or education will
eventually reveal themselves in the
hospital, both in its staff and in the
patients committed to their care.
To apply this thought to a specific
situation, we might consider Gaston
Memorial Hospital, a 228-bed, 31-
bassinet, short-term, general, com-munity
hospital, operated by a board
of trustees composed of 12, who serve
without pay and represent the various
towns in Gaston County. The day-to-day
operation of the hospital is dele-gated
by the trustees to an experi-enced
hospital director, James A.
Brown, Jr. Qualified department heads
in turn supervise their specific areas
of service.
The hospital is fully accredited by
the Joint Commission on Accreditation
of Hospitals and licenced by the
North Carolina Medical Care Com-mission.
Among the patient services offered
at GMH are fully equipped clinical
laboratories directed by a pathologist,
a pharmacy, physical therapy depart-ment,
intensive care unit, operating
and obstetrical suites, and dental
facilities. Both diagnostic and ther-apeutic
X-ray services are supervised
by a team of three radiologists.
The medical staff is made up of
dedicated and skilled physicians and
surgeons, representing all of the
major specialties with board certified
men. A dental staff is also a part of
the medical staff.
A full-time chaplain, who is an
ordained minister with additional
training in the hospital chaplaincy,
counsels and ministers to patients,
bereaved families, student nurses, and
employees. He works closely with the
doctors and local ministers.
Auxiliary Hospital
We are proud of our hospital aux-iliary,
organized in 1952, that has
served us faithfully in countless ways.
Its present membership numbers 250.
A very active junior auxiliary "Candy-stripers"
step into volunteer service
positions throughout the hospital as
soon as summer arrives. The program
is headed by a director of volunteers
who is a member of the hospital staff.
Gaston Memorial maintains and
operates its own modern laundry. This
building also houses the housekeeping,
engineering, and sewing departments.
The laundry, turning out 100,000
pounds of wash every month, has
experimented successfully with the
employment of women in the upper
age brackets only. Most of these
women are in the social security
bracket and have proven very depend-able.
They seem to enjoy their light,
part time duties arranged on an
alternating shift basis between two
groups.
During this past year, Gaston
Memorial Hospital recorded 10,499
adult and pediatric admissions, with
67,641 days of care rendered.
Emergency departments in many
of the nation's 7,000 hospitals have
been under increasing pressure, in
recent years, resulting from the
changing role of the department from
a true emergency room to an out-patient
clinic. This has been our
experience as well, with 21,934 emer-gency
room visits in one year. This
is a climb from 16,177 in 1960. To ease
the situation in our emergency suite,
changes have just been completed,
adding space for more patients and a
more comfortable outpatient waiting
area. Traffic patterns have been re-designed,
gaining a separate entrance
for stretchers with more direct access
to the emergency room.
Three Per Patient
It is generally accepted that to give
proper care a hospital needs two and
one-half to three employees per every
A freshman class at the Gaston Memorial Hospital School of Nursing receives instruction from registered nurses Mrs. Larry Kennedy and
Miss Louise Taylor (left). Mrs. Wade Carter, recovery room nurse (right) administers to patients with complete and up-to-date facilities.
28 ESC QUARTERLY
patient. Since a hospital is by neces-sity
open 24 hours, seven days a
week, there are many jobs that must
be covered around the clock. Filling
these occupations requires four and
one-half persons each, to allow for
vacations, days off, etc. In a tight
labor market these facts can offer a
challenge to department heads and the
personnel officer.
In pointing up the effect of the
community on the hospital, there are
several factors that can be brought
out. The population growth of Gaston
County has been on an upward swing
for a number of years. During the
ten year period from 1950 to 1960,
the city of Gastonia experienced an
increase of 61.4 percent, and the
county increased by 15 percent. In
this same ten year period, Gaston
Memorial Hospital grew from 65 beds
to 198 beds.
Along with the population increase,
industrial growth took place at such
a pace that it raised Gaston County to
second in the state with industries
employing more than 100 persons.
As these diversified industries have
located in the county, attracting much
of the available personnel, unemploy-ment
has hit a record low. This has
brought about increases in real in-come,
with the majority of today's
employees receiving generous fringe
benefits, including hospitalization, and
as income has increased, the demand
for hospital and health services has
increased accordingly. Additional pro-grams
sponsored by the government,
such as Medicare and the anti-poverty
programs will create the need for
medical and hospital services beyond
the normally expected increases.
Bond Issue Rejected
These community development
trends are important in the long-range
planning of bed needs by hospital
authorities. It is not secret that at
the present time, Gaston Memorial
Hospital with 228 beds is far short
of being adequate to meet the needs
of a county that shows a population
of 135,836 in a recently completed
census. Furthermore, only 140 of the
total bed count can be considered
"acceptable" beds by hospital stand-ards.
The current bed count was
reached by putting two beds in rooms
designed for one, and by placing beds
in corridors and alcoves. This has
been necessary in order to keep pace
with the demands placed on the hos-pital
facilities by a growing com-munity,
and in view of this need, the
board of trustees recently approached
the citizens with a plan to build a
400-bed hospital on a new site. The
building program was dependent on a
bond issue, which was rejected by the
voters of the community. Disappoint-ment
in the hoped for relief from
crowded conditions has had some
effect on our staffing situation.
In reviewing the existing staff
vacancies, it appears that the openings
are mainly on two levels: the profes-sional,
and the unskilled. Despite the
terminology, this latter group is im-portant
to the efficient performance
of food and housekeeping services, to
name a few.
It is easy to understand why a
hospital might be short of non-skilled
personnel with a tight labor market
and industrial wage scales that can-not
be met by a non-profit organiza-tion.
But what about the professional
people whose training is geared solely
to giving hospital care ? Where are
they?
In the first place, the nursing situ-ation
in North Carolina has been
described by experts as being acute.
Results of a survey made by the
Duke Endowment in 1962, showed a
total of 2,106 unfilled full-time posi-tions
for professional nurses in this
state. In addition to the actual short-
.- 1
Administrators of the Gastonia Memorial Hospital include Miss Margaret Cudd, R.N.,
director of nursing; James A. Brown, Jr., hospital director; Jefferson C. McDuffie, person-nel
director; and Bill McSwain, comptroller.
age of nurses, prosperity has made
its mark. With increased family in-come,
the nurse does not have to leave
her family and work the necessary
tours of duty in the hospital. Too,
it has become increasingly difficult
to obtain reliable household help, so
that a young mother can be free to
work. This very situation is one affect-ing
our medical records department
at the present time. It seems that an
important service could be performed
by the anti-poverty program in edu-cating
people who need work but
still reject so-called unskilled jobs as
subservient and therefore undesirable.
Moreover, this program could work
out a training in hospital services that
would relieve the hard core of profes-sional
help that remains available.
Seeks Relief
Gaston Memorial Hospital itself
makes a contribution toward relief
of the nursing shortage through its
work in nursing education in its two
schools: the three-year diploma school
for professional nurses, and the one-year
practical nursing school.
The professional school enrolled its
first class on January 15, 1947, just
one year after the hospital was
organized. The school holds as its
central objective the preparation of
selected individuals to practice pro-fessional
nursing in first level posi-tions
in general hospitals. In its
desire to offer a high level of nursing
education, the school is affiliated with
Gaston College, and the students
receive college credit for courses
taken there.
During their senior year, profes-sional
students attend classes at
Dorothea Dix Hospital in Raleigh, for
their psychiatric nursing education.
Students are also exposed to com-munity
resource agencies such as
will aid in the study of both the
normal and the handicapped child.
The school of nursing has facilities
to accommodate 100 students and oc-cupies
a modern, attractive, and well-equipped
building. The students enjoy
their own tennis and basketball courts
and take advantage of both the study
and recreational advantages offered
them.
The school curriculum is reviewed
frequently and upgraded under the
direction of Miss Margaret Cudd,
R. N., director of nursing, and Miss
Louise Taylor, R. N., associate direc-tor
of nursing education.
Gaston Memorial Hospital also
maintains a school of practical nurs-ing,
which graduated its second class
in March of this year. Students
completing this course of study are
then eligible to take their state board
examinations for licensing of practical
nurses. The school presents a balanced
(See GASTON, page 33)
ESC QUARTERLY 29
NCSNA Blames Nurse Shortage On
Low Salaries, Inadequate Training Plan
By Marie B. Noell
Executive Secretary, N. C. State Nurses Association
Today there are more and better
prepared nurses in North Carolina
than ever before.
Yet in nearly every community of
the State there is considerable public
attention and concern about the
shortage of nurses. Many experts feel
that with the impact of the Medicare
program, the shortage of nurses will
become even more severe.
The most recent state-wide survey
of nurse needs among users of pro-fessional
nurses indicates that there
are more than 2,000 unfilled full-time
positions. There are more than 15,000
registered nurses in North Carolina,
and about 12,300 of them are prac-ticing.
Some 2,500 are listed as "in-active."
The largest group of nurses,
of course, is practicing in hospitals
or other institutions—some 8,100.
About 475 are teaching in schools of
professional nursing and in practical
nurse programs. Another 1,350 are
in private duty practice, while nearly
700 are in public health. There are
about 225 occupational health nurses
in North Carolina, and more than
1,175 engaged in nursing in doctors'
offices. The remainder are in school
nursing and other specified fields. The
shortage is being felt in all areas of
practice, and it is a national one.
In a Report of Survey of Nursing
Education in North Carolina publish-
New methods of health services are
demonstrated to a group of nurses at-tending
a clinical meeting.
ed in July, 1964, author Ray E.
Brown states that North Carolina is
"doomed to a chronic and severe nurs-ing
shortage for the next decade."
The number of graduates produced
annually by the State's schools of
nursing is not nearly enough to fill
the gap.
There are several reasons why
there are not enough nurses to ful-fill
North Carolina's nursing needs.
First, Hill-Burton funds have en-abled
communities in this State to
build and expand hospitals and other
health care facilities rapidly, but
there was no accompanying plan to
provide the skilled personnel to staff
these facilities. Second, the low
salaries and unfavorable working con-ditions
of nursing positions have
caused many promising young people
to turn to other more lucrative and
more attractive careers. In recent
years many new career opportunities
have opened up to young people,
especially to women, who might other-wise
have gone into nursing.
A third reason is the poor quality
of nursing education programs, re-sulting
in a high percentage of fail-ures
in the licensure examination.
Foster High Standards
The North Carolina State Nurses'
Association, membership organization
for registered nurses, has served as
the spokesman through which nurses
have sought for many years to call
these facts to the attention of the
public. The functions of NCSNA are
to foster high standards of nursing
practice, to promote the professional
and educational advancement of
nurses, and to promote the welfare of
nurses—all to the end that all people
may have better nursing care.
NCSNA is a constituent unit of the
American Nurses' Association.
With the establishment of the
North Carolina Medical Care Com-mission
to serve as the official state
agency to administer Hill-Burton
funds, the NCSNA began to seek
ways to increase the supply of pre-pared
nurses to staff the new hospi-tals
and clinics springing up all over
the State. Efforts to obtain state
funds for scholarships for nurses
were not successful until recent years.
Now a loan-scholarship program for
the health professions is administered
through the Medical Care Commis-sion
and is used heavily by nurses
both in basic programs and in gradu-ate
work.
The American Nurses' Association
was successful in 1964 in obtaining
passage of the Nurse Training Act,
under which low-interest loans are
available to nurses; traineeships are
continued for nurses in teaching, ad-ministration
and supervision, and
public health; and construction
grants and project grants are avail-able
to schools of nursing.
Improving the economic situation
of nurses presents a more formidable
problem. This problem has always
plagued the nursing profession. To-day
a beginning nurse, with her post-high
school preparation, receives a
beginning salary less than the na-tional
average for factory workers.
Her working schedule involves eve-ning
and night shifts and weekends.
Fringe benefits are poor. Most nurses
work in non-profit hospitals which are
exempt from the protective labor
legislation other workers enjoy.
To improve the working conditions
of nurses so that the profession can
compete as a career, NCSNA conducts
a continuous program of promoting
salary improvements, better fringe
benefits, more